高通量血液透析对老年糖尿病肾病患者心功能超声指标、血清心肌损伤及炎症生化指标的远期改善作用

杨建享; 林永强

doi:10.16766/j.cnki.issn.1674-4152.003756

高通量血液透析对老年糖尿病肾病患者心功能超声指标、血清心肌损伤及炎症生化指标的远期改善作用

doi: 10.16766/j.cnki.issn.1674-4152.003756

杨建享^1, ,,
林永强²

1.
温州市中西医结合医院超声科，浙江温州 325000
2.
温州市中西医结合医院肾内风湿免疫科

基金项目:

浙江省中医药科技计划项目 2023ZL676

详细信息

通讯作者:
杨建享，E-mail：jevons1984@163.com

中图分类号: R587.2 R459.5
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- 文章访问数: 13
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- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2024-05-10
- 网络出版日期: 2024-12-31

The long-term improvement effect of high flux hemodialysis on cardiac function ultrasound index, serum myocardial injury and inflammatory biochemical index in elderly patients with diabetic nephropathy

YANG Jianxiang^{1
, ,},
LIN Yongqiang²

1.
Ultrasound Department, Wenzhou Chinese and Western Medicine Hospital, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的针对老年糖尿病肾病(DN)维持性血液透析(MHD)患者进行高通量透析(HFHD)治疗，评估治疗对患者心功能超声指标、血清心肌损伤及炎症生化指标的远期改善作用。方法选择2022年3月—2023年3月于温州市中西医结合医院接受MHD治疗的93例老年DN患者，根据患者需要和透析目的将其分为HFHD组42例和低通量透析(LFHD)组51例，并分别进行高通量透析和低通量透析。追踪治疗效果1年，并于追踪期结束比较患者组内、组间心功能超声指标、血清心肌损伤、炎症生化指标以及不良反应发生率差异。结果组内比较结果显示：治疗后，HFHD组患者左室舒张末期内径(LVDD)降低，左室射血分数(LVEF%)与舒张早期E峰值与舒张晚期A峰值的比值(E/A)上升，血清超敏肌钙蛋白Ⅰ(hs-TNⅠ)水平也呈现上升趋势(P＜0.05)；LFHD组hs-TNⅠ、Hcy、超敏C反应蛋白(hs-CRP)水平显著上升(P＜0.05)。组间比较结果显示：治疗后，HFHD组LVDD、室间隔舒张期厚度(IVSDT)较LFHD组显著下降，LVEF%和E/A较LFHD组显著上升；HFHD组血清肌酸激酶同工酶质量(CK-MBmass)、hs-TNⅠ、同型半胱氨酸(Hcy)以及hs-CRP水平均显著低于LFHD组。HFHD组透析不良反应总发生率为11.90%(5/42)，显著低于LFHD组[47.06%(24/51)，P＜0.001]。结论老年糖尿病肾病维持性血液透析患者行高通量透析治疗，可有效改善心功能，延缓心肌损伤水平，且安全性较高。
- 糖尿病肾病 /
- 维持性血液透析 /
- 超声 /
- 高通量透析 /
- 心肌损伤
Abstract: Objective High-flux hemodialysis (HFHD) was performed in elderly patients with diabetic nephropathy (DN) maintenance hemodialysis (MHD) to evaluate the long-term improvement of cardiac function ultrasound index, serum myocardial injury, and inflammatory biochemical index. Methods A total of 93 elderly patients with DN who received MHD treatment in Wenzhou Chinese and Western Medicine Hospital from March 2022 to March 2023 were selected and divided into a HFHD group (n=42) and a low-flux dialysis (LFHD) group (n=51) according to patients' needs and dialysis purposes. High-flux dialysis and low-flux dialysis were performed respectively, and the treatment effect was followed up for 1 year. At the end of the follow-up period, the differences in cardiac function ultrasound indexes, serum myocardial injury, inflammatory biochemical indexes, and incidence of adverse reactions were compared between the two groups. Results The results of intra-group comparison showed that; after treatment, the left ventricular end-diastolic diameter (LVDD) in the HFHD group decreased, the left ventricular ejection fraction (LVEF%) and the ratio of early diastolic E peak to late diastolic A peak (E/A) increased, and the serum high-sensitivity troponin Ⅰ (hs-TNⅠ) level also showed an upward trend (P < 0.05). The levels of hs-TNⅠ, Hcy, and hs-CRP in the LFHD group were significantly increased (P < 0.05). The results of inter-group comparison showed that after the treatment, LVDD and interventricular septum diastolic thickness (IVSDT) in the HFHD group were significantly lower than those in the LFHD group, while LVEF% and E/A were significantly higher than those in the LFHD group. The levels of serum creatine kinase isoenzyme mass (CK-MBmass), hs-TNⅠ, homocysteine (Hcy), and hypersensitive C-reactive protein (hs-CRP) in the HFHD group were significantly lower than those in the LFHD group. The total incidence of dialysis adverse reactions in the HFHD group was 11.90% (5/42), which was significantly lower than that in the LFHD group (47.06%, 24/51, P < 0.001). Conclusion HFHD treatment in elderly DN MHD patients can effectively improve cardiac function and delay myocardial injury with high safety.
- Diabetic nephropathy /
- Maintenance hemodialysis /
- Ultrasound /
- High flux dialysis /
- Myocardial injury

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表 1 2组老年糖尿病肾病患者一般资料比较

Table 1. Comparison of general data between the two groups of elderly patients with diabetic nephropathy

组别	例数	性别[例(%)]		年龄(x±s，岁)	病程[M(P₂₅, P₇₅)，年]	透析时间[M(P₂₅, P₇₅)，月]	高血压[例(%)]		高脂血症[例(%)]		冠心病[例(%)]
组别	例数	男性	女性	年龄(x±s，岁)	病程[M(P₂₅, P₇₅)，年]	透析时间[M(P₂₅, P₇₅)，月]	是	否	是	否	是	否
HFHD组	42	24(57.14)	18(42.86)	69.83±5.25	5.00(4.00，7.00)	40.50(32.00，50.25)	20(47.62)	22(52.38)	14(33.33)	28(66.67)	11(26.19)	31(73.81)
LFHD组	51	32(62.75)	19(37.25)	69.27±4.44	5.00(3.00，6.00)	40.00(19.00，48.00)	25(49.02)	26(50.98)	12(23.53)	39(76.47)	14(27.45)	37(72.55)
统计量		0.302^a		0.556^b	-1.320^c	-1.637^c	0.018^a		1.099^a		0.019^a
P值		0.583		0.579	0.187	0.102	0.893		0.294		0.891
注：^a为χ²值，^b为t值，^c为U值。

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表 2 2组老年糖尿病肾病患者治疗前后心功能指标比较(x±s)

Table 2. Comparison of cardiac function indexes before and after treatment in the two groups of elderly patients with diabetic nephropathy (x±s)

组别	例数	LVDD(mm)		IVSDT(mm)		LVEF(%)		E/A
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
HFHD组	42	54.76±3.53	51.76±3.45^b	12.11±1.22	11.65±0.97	55.87±3.83	62.46±3.91^b	0.72±0.06	0.86±0.06^b
LFHD组	51	55.44±2.82	54.33±3.51	12.23±1.12	12.05±0.71	55.27±4.09	56.43±4.57	0.71±0.06	0.73±0.06
统计量		-1.034^a	11.796^c	-0.492^a	5.377^c	0.720^a	44.423^c	1.113^a	101.035^c
P值		0.304	0.001	0.624	0.023	0.473	＜0.001	0.268	＜0.001
注：^a为t值，^c为F值；与同组治疗前比较，^bP＜0.05。

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表 3 2组老年糖尿病肾病患者治疗前后心肌损伤、炎症生化指标比较(x±s)

Table 3. Comparison of myocardial injury and inflammatory biochemical indexes before and after treatment between two groups (x±s)

组别	例数	CK-MBmass(ng/mL)		hs-TNⅠ(pg/mL)		Hcy(μmol/L)		hs-CRP(mg/L)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
HFHD组	42	1.74±0.53	1.87±0.52	35.34±18.28	47.20±19.03^c	36.64±6.42	37.90±5.50	4.04±1.47	4.18±1.42
LFHD组	51	2.03±0.82	2.25±0.83	32.52±15.15	52.73±17.20^c	38.24±6.30	41.14±5.39^c	3.93±1.23	4.42±1.19^c
统计量		-1.945^a	7.043^b	0.815^a	23.451^b	-1.213^a	11.261^b	0.375^a	11.346^b
P值		0.055	0.009	0.415	＜0.001	0.228	0.001	0.708	0.001
注：^a为t值，^b为F值；与同组治疗前比较，^cP＜0.05。

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表 4 2组老年糖尿病肾病患者不良反应发生情况比较[例(%)]

Table 4. Comparison of adverse reactions between the two groups of elderly patients with diabetic nephropathy [cases (%)]

组别	例数	发热	静脉压升高	低血压	肌肉痉挛	酸碱平衡失调	钙磷代谢紊乱	肾性贫血	感染	不良反应总发生
HFHD组	42	0	0	1(2.38)	1(2.38)	0	1(2.38)	1(2.38)	1(2.38)	5(11.90)
LFHD组	51	2(3.92)	1(1.96)	4(7.84)	3(5.88)	4(7.84)	2(3.92)	5(9.80)	3(5.88)	24(47.06)
χ²值				0.490	0.099	1.800	＜0.001	1.053	0.099	13.264
P值		0.499^a	0.999^a	0.484	0.753	0.180	0.999	0.305	0.753	＜0.001
注：^a为采用Fisher精确检验。

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