CAJ | 학술논문

目的观察高通量血液透析(血透)对老年糖尿病肾病患者胰岛素抵抗(IR)和微炎症状态的影响. 方法选择我中心老年糖尿病肾病维持性血透患者(透析组)49例及健康体检老年人(对照组)10例,比较两组胰岛素抵抗指数(HOMA-IR)、白细胞介素-6(IL-6)、高敏C反应蛋白(hs-CRP)水平,并进行相关性分析.随机将患者分为高通量透析和低通量透析两组,治疗12个月,分别观察两组患者治疗前、后HOMA-IR、IL-6、hs-CRP、尿素清除率(kt/v)等指标的变化. 结果老年透析组患者IL-6、hs-CRP和HOMA-IR水平均显著高于对照组,分别为(126.22±13.23)ng/L比(12.68±3.63)ng/L、(12.13±1.73) mg/L比(2.55±1.27)mg/L和4.83±1.23比0.32±0.15,差异均有统计学意义(P＜0.01)；IL-6、hs-CRP均与HOMA-IR呈正相关(R=0.656、0.729,R2=0.43、0.532,均P＜0.0l).治疗12个月后,高通量组空腹胰岛素、HOMA-IR、II-6较治疗前明显降低(P＜0.05)；与低通量组比较,空腹胰岛素、HOMA-IR、hs-CRP显著降低(P＜0.05).低通量组空腹胰岛素、HOMA-IR、IL-6、hs-CRP治疗前、后比较,差异无统计学意义(P＞0.05). 结论老年糖尿病肾病维持性血透患者体内普遍存在IR和微炎症状态；高通量透析较低通量透析能有效改善其IR,降低IL-6、hs-CRP水平,改善微炎症状态.
목적 관찰고통량혈액투석(혈투)대노년당뇨병신병환자이도소저항(IR)화미염증상태적영향. 방법 선택아중심노년당뇨병신병유지성혈투환자(투석조)49례급건강체검노년인(대조조)10례,비교량조이도소저항지수(HOMA-IR)、백세포개소-6(IL-6)、고민C반응단백(hs-CRP)수평,병진행상관성분석.수궤장환자분위고통량투석화저통량투석량조,치료12개월,분별관찰량조환자치료전、후HOMA-IR、IL-6、hs-CRP、뇨소청제솔(kt/v)등지표적변화. 결과 노년투석조환자IL-6、hs-CRP화HOMA-IR수평균현저고우대조조,분별위(126.22±13.23)ng/L비(12.68±3.63)ng/L、(12.13±1.73) mg/L비(2.55±1.27)mg/L화4.83±1.23비0.32±0.15,차이균유통계학의의(P＜0.01)；IL-6、hs-CRP균여HOMA-IR정정상관(R=0.656、0.729,R2=0.43、0.532,균P＜0.0l).치료12개월후,고통량조공복이도소、HOMA-IR、II-6교치료전명현강저(P＜0.05)；여저통량조비교,공복이도소、HOMA-IR、hs-CRP현저강저(P＜0.05).저통량조공복이도소、HOMA-IR、IL-6、hs-CRP치료전、후비교,차이무통계학의의(P＞0.05). 결론 노년당뇨병신병유지성혈투환자체내보편존재IR화미염증상태；고통량투석교저통량투석능유효개선기IR,강저IL-6、hs-CRP수평,개선미염증상태.
Objective To investigate the effect of high-flux hemodialysis on insulin resistance and microinflammatory state in elderly diabetic nephropathy (DN) patients with maintenance hemodialysis(MHD).Methods A total of 49 elderly DN patients with MHD and 10 healthy controls undergoing health examination survey were enrolled.Levels of homeostasis model assessment of insulin resistance index(HOMA-IR),interleukin-6(IL-6) and high sensitivity C-reactive protein(hs-CRP) were analyzed and compared between patients and the controls.Patients with MHD were randomly divided into two groups:high-flux hemodialysis(HFHD) group and low-flux hemodialysis (LFHD) group.Changes of the parameters including HOMA-IR,IL-6,hs CRP and urea excretion rate(kt/v) were observed before and after treatment for 12 months.Results Levels of IL-6,hs-CRP and HOMA-IR were significantly higher in DN patients with MHD than in the control group [(126.22±13.23)ng/L vs.(12.68±3.63)ng/L,(12.13±1.73)mg/L vs.(2.55±1.27) mg/L,(4.83 ±1.23) vs.(0.32 ± 0.15),respectively,all P＜ 0.01].The levels of IL-6 and Hs-CRP were positively correlated with HOMA-IR in elderly DN patients (R =0.656,0.729,R2 =0.43,0.532,both P＜0.01).Compared with before treatment,levels of fasting insulin(Fins),HOMA-IR and IL-6 were decreased in HFHD group after MHD for 12 months (all P＜ 0.05),while there were no differences in levels of Fins,HOMA-IR,IL-6 and hs-CRP in the LFHD group before and after MHD (all P＞0.05).The levels of Fins,HOMA-IR and IL-6 were significantly lower in the HFHD group than in the LFHD group after MHD for 12 months(all P＜0.05).Conclusions Insulin resistance and microinflammatory are common observed in elderly DN patients with MHD.High-flux hemodialysis may decrease the levels of IL-6 and hs-CRP,and ameliorate insulin resistance and microinflammatory state.