中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2013年
6期
582-585
,共4页
沈文清%邢艳芳%黄丽%钱捷%赵世莉
瀋文清%邢豔芳%黃麗%錢捷%趙世莉
침문청%형염방%황려%전첩%조세리
血液透析滤过%微炎症状态%甲状旁腺激素%心功能
血液透析濾過%微炎癥狀態%甲狀徬腺激素%心功能
혈액투석려과%미염증상태%갑상방선격소%심공능
Hemodiafiltration%Micro-inflammation%Parathyroid hormone%Cardiac function
目的 观察血液透析滤过(HDF)对尿毒症维持性血液透析患者超敏C反应蛋白(hs-CRP)、甲状旁腺激素(iPTH)以及心功能的影响.方法 选择尿毒症患者40例,分为HDF组20例和普通血液透析(HD)组20例.两组患者分别在治疗前及治疗6个月后测定血清hs-CRP、iPTH浓度；彩色多普勒超声检测左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、室间隔厚度(IVST)、左心室射血分数(LVEF)；选择健康志愿者10名作为对照组进行分析比较.结果 HDF组治疗后hs-CRP[(3.32±1.14) mg/L]、iPTH[(155.36±81.33) ng/L]水平较治疗前[(7.84±2.21) mg/L、(190.25±82.31) ng/L]明显降低,差异有统计学意义(t=2.072,P=0.046；t=2.121,P=0.023).HD组治疗后hs-CRP[(7.91±2.11) mg/L]、iPTH[(177.43±85.43) ng/L]水平较治疗前[(7.68±1.86) mg/L、(184.35±87.21) ng/L]无明显变化(t=1.731,P=0.111；t=1.331,P=0.210).治疗后心脏结构的各项指标得到改善,HDF组治疗后LVEDD (55.3±3.7) mm,LVESD (33.5±2.6) mm,IVST (10.2±1.7)mn,LVEF (55.3±2.6)％,LVMI (132.5±9.1)g/m2较治疗前[LVEDD (58.8±4.3) mm,LVESD(36.4±4.3) mm,IVST (13.1±1.8) mm,LVEF (42.5±3.3)％,LVMI(137.4±8.7) g/m2]明显改善(t=2.345,P=0.015;t=2.178,P =0.046;t =2.630,P =0.012;t=2.860,P =0.010;t =2.871,P=0.009),HDF组治疗后优于HD组[LVEDD (59.1±4.2)mm,LVESD (36.1±3.4) mm,IVST(12.4±1.3) mm,LVEF (43.4±2.7)％,LVMI(139.4±8.9) g/m2],差异有统计学意义(P均＜0.05).6个月治疗期间HDF组心血管事件发生率[36.39％(524/1440)]显著少于HD组[72.08％ (1038/1440)],差异有统计学意义(x2 =21.583,P＜0.01).结论 HDF治疗可以更好地清除尿毒症患者体内甲状旁腺激素,改善患者微炎症状态和心脏功能.
目的 觀察血液透析濾過(HDF)對尿毒癥維持性血液透析患者超敏C反應蛋白(hs-CRP)、甲狀徬腺激素(iPTH)以及心功能的影響.方法 選擇尿毒癥患者40例,分為HDF組20例和普通血液透析(HD)組20例.兩組患者分彆在治療前及治療6箇月後測定血清hs-CRP、iPTH濃度；綵色多普勒超聲檢測左心室舒張末期內徑(LVEDD)、左心室收縮末期內徑(LVESD)、室間隔厚度(IVST)、左心室射血分數(LVEF)；選擇健康誌願者10名作為對照組進行分析比較.結果 HDF組治療後hs-CRP[(3.32±1.14) mg/L]、iPTH[(155.36±81.33) ng/L]水平較治療前[(7.84±2.21) mg/L、(190.25±82.31) ng/L]明顯降低,差異有統計學意義(t=2.072,P=0.046；t=2.121,P=0.023).HD組治療後hs-CRP[(7.91±2.11) mg/L]、iPTH[(177.43±85.43) ng/L]水平較治療前[(7.68±1.86) mg/L、(184.35±87.21) ng/L]無明顯變化(t=1.731,P=0.111；t=1.331,P=0.210).治療後心髒結構的各項指標得到改善,HDF組治療後LVEDD (55.3±3.7) mm,LVESD (33.5±2.6) mm,IVST (10.2±1.7)mn,LVEF (55.3±2.6)％,LVMI (132.5±9.1)g/m2較治療前[LVEDD (58.8±4.3) mm,LVESD(36.4±4.3) mm,IVST (13.1±1.8) mm,LVEF (42.5±3.3)％,LVMI(137.4±8.7) g/m2]明顯改善(t=2.345,P=0.015;t=2.178,P =0.046;t =2.630,P =0.012;t=2.860,P =0.010;t =2.871,P=0.009),HDF組治療後優于HD組[LVEDD (59.1±4.2)mm,LVESD (36.1±3.4) mm,IVST(12.4±1.3) mm,LVEF (43.4±2.7)％,LVMI(139.4±8.9) g/m2],差異有統計學意義(P均＜0.05).6箇月治療期間HDF組心血管事件髮生率[36.39％(524/1440)]顯著少于HD組[72.08％ (1038/1440)],差異有統計學意義(x2 =21.583,P＜0.01).結論 HDF治療可以更好地清除尿毒癥患者體內甲狀徬腺激素,改善患者微炎癥狀態和心髒功能.
목적 관찰혈액투석려과(HDF)대뇨독증유지성혈액투석환자초민C반응단백(hs-CRP)、갑상방선격소(iPTH)이급심공능적영향.방법 선택뇨독증환자40례,분위HDF조20례화보통혈액투석(HD)조20례.량조환자분별재치료전급치료6개월후측정혈청hs-CRP、iPTH농도；채색다보륵초성검측좌심실서장말기내경(LVEDD)、좌심실수축말기내경(LVESD)、실간격후도(IVST)、좌심실사혈분수(LVEF)；선택건강지원자10명작위대조조진행분석비교.결과 HDF조치료후hs-CRP[(3.32±1.14) mg/L]、iPTH[(155.36±81.33) ng/L]수평교치료전[(7.84±2.21) mg/L、(190.25±82.31) ng/L]명현강저,차이유통계학의의(t=2.072,P=0.046；t=2.121,P=0.023).HD조치료후hs-CRP[(7.91±2.11) mg/L]、iPTH[(177.43±85.43) ng/L]수평교치료전[(7.68±1.86) mg/L、(184.35±87.21) ng/L]무명현변화(t=1.731,P=0.111；t=1.331,P=0.210).치료후심장결구적각항지표득도개선,HDF조치료후LVEDD (55.3±3.7) mm,LVESD (33.5±2.6) mm,IVST (10.2±1.7)mn,LVEF (55.3±2.6)％,LVMI (132.5±9.1)g/m2교치료전[LVEDD (58.8±4.3) mm,LVESD(36.4±4.3) mm,IVST (13.1±1.8) mm,LVEF (42.5±3.3)％,LVMI(137.4±8.7) g/m2]명현개선(t=2.345,P=0.015;t=2.178,P =0.046;t =2.630,P =0.012;t=2.860,P =0.010;t =2.871,P=0.009),HDF조치료후우우HD조[LVEDD (59.1±4.2)mm,LVESD (36.1±3.4) mm,IVST(12.4±1.3) mm,LVEF (43.4±2.7)％,LVMI(139.4±8.9) g/m2],차이유통계학의의(P균＜0.05).6개월치료기간HDF조심혈관사건발생솔[36.39％(524/1440)]현저소우HD조[72.08％ (1038/1440)],차이유통계학의의(x2 =21.583,P＜0.01).결론 HDF치료가이경호지청제뇨독증환자체내갑상방선격소,개선환자미염증상태화심장공능.
Objective To study the influence of hemodiafiltration on high-sensitivity C-reactive protein (hs-CRP),serum parathyroid hormone (iPTH) and cardiac function in uremic patients undergoing maintenance hemodialysis (MHD).Methods Forty patients with uremia were divided into hemodiafiltration (HDF) group (n =20) and hemodialysis(HD) group(n =20) by random numbers.Serum hs-CRP and iPTH were measured before treatment and at 6 months after treatment.Their left ventricular diastolic diameter (LVEDD),left ventricular end-systolic dimension (LVESD),interventricular septal thickness (IVST) and left ventricular ejection fraction(LVEF) were measured by echocardiogram.Ten healthy volunteers were recruited as the normal controls.Results After treatment,serum hs-CRP and iPTH decreased significantly in the HDF group (hs-CRP:(3.32±1.t4) mg/L vs.(7.84 ±2.21) mg/L,t =2.072,P =0.046;iPTH:(155.36 ±81.33) ng/L vs.(190.25 ±82.31) ng/L,t =2.121,P =0.023).No significant difference of serum hs-CRP and iPTH was observed in the HD group before and after treatment (hs-CRP:(7.91 ±2.11) mg/L vs.(7.68 ± 1.86) mg/L,t =1.731,P =0.111 ; iPTH:(177.43 ± 85.43) ng/L vs.(184.35 ± 87.21) ng/L,t =1.331,P =0.210).Color Doppler indices of cardiac structure of the HDF group significantly improved after treatment compared with before treatment (LVEDd:(55.3 ±3.7) mm vs.(58.8 ±4.3) mm,t =2.345,P =0.015 ;LVESd:(33.5 ±2.6) mm vs.(36.4±4.3) mm,t=2.178,P=0.046;IVST:(10.2±1.7) mmvs.(13.1 ±1.8) mm,t=2.630,P=0.012;LVEF:(55.3 ±2.6)％ vs.(42.5 ±3.3)％,t =2.860,P =0.010;LVMI:(132.5 ±9.1)g/m2 vs.(137.4 ± 8.7) g/m2,t =2.871,P =0.009).After treatment,cardiac structure of the HDF group was significantly better than that of the HD group (LVEDd:(55.3 ± 3.7) mm vs.(59.1 ± 4.2) mm,LVESd:(33.5 ±2.6) mm vs.(36.1 ±3.4) mm,IVST:(10.2±1.7) vs.(12.4 ±1.3) mm,LVEF:(55.3 ±2.6)％vs.(43.4±2.7)％,LVMI:(132.5 ±9.1) g/m2 vs.(139.4 ±8.9) g/m2;P ＜0.05).During the six month treatment,the incidence rate of cardiovascular events of the HDF group was significantly less than the HD group (36.39％(524/1440) vs.(72.08(1038/1440),x2 =21.583,P＜0.01).Conclusion HDF may efficiently remove iPTH,improve cardiac function of uremic patients,and help them recover from micro-inflammatory state.
