不同血液净化方式对糖尿病肾病慢性肾衰竭患者血清脂肪因子及炎性因子水平的影响分析

李成 闵军 林成实 侯仲铨 林萍萍 陈亮 雷霆 陈晓 马剑清

[摘要] 目的 分析不同血液凈化方式对糖尿病肾病慢性肾衰竭患者血清脂肪因子及炎性因子水平的影响。方法 该次研究所选择的对象是2018年12月—2019年12月期间该院收治的糖尿病肾病慢性肾衰竭患者74例，根据不同的血液净化方式将患者分成了观察组和对照组，观察组通过连续性血液净化治疗，对照组通过维持性血液透析治疗，对比两组患者的治疗效果、基线肾功能、治疗前后脂肪因子、治疗前后炎症因子水平、生活质量。结果 观察组的治疗效果为94.59%，高于对照组的75.68%（P<0.05）。观察组的空腹血糖、尿素氮、血肌酐、24 h尿蛋白量等基线肾功能分别为（14.36±3.13）mmol/L、（14.23±4.22）mmol/L、（483.43±41.28）μmol/L、（2.38±1.02）mg，与对照组相比差异无统计学意义（P>0.05）。观察组的治疗前后脂联素、抵抗素、瘦素等脂肪因子分别为（4.51±1.86）μg/mL、（1.52±1.92）μg/mL、（13.92±5.62）μg/mL、（7.23±4.32）μg/mL、（6.22±2.45）μg/mL、（2.84±2.33）μg/mL，治疗后与对照组相比差异有统计学意义（P<0.05）。观察组的治疗前后IL-6、TNF-α等炎症因子水平分别为（213.63±37.42）pg/mL、（168.72±27.47）pg/mL、（153.62±41.33）pg/mL、（99.44±22.17）pg/mL，治疗后与对照组相比差异有统计学意义（P<0.05）。观察组的心理健康、生理健康、社会生活等生活质量分别为（23.9±4.53）分、（6.68±1.75）分、（8.37±2.16）分，均要高于对照组（P<0.05）。结论 不同血液净化方式对糖尿病肾病慢性肾衰竭患者血清脂肪因子及炎性因子水平的影响不同，其中连续性血液净化治疗的效果比较好。

[关键词] 血液净化;糖尿病肾病慢性肾衰竭;血清脂肪因子;炎性因子水平

[中图分类号] R587.1          [文献标识码] A          [文章编号] 1672-4062（2020）09（a）-0175-03

[Abstract] Objective To analyze the effects of different blood purification methods on the levels of serum adipokines and inflammatory factors in patients with diabetic nephropathy and chronic renal failure. Methods The subjects selected in this study were all 74 patients with diabetic nephropathy and chronic renal failure admitted to our hospital from December 2018 to December 2019. The patients were divided into observation group and control group according to different blood purification methods. The observation group received continuous blood purification treatment， and the control group received maintenance hemodialysis treatment. The treatment effects， baseline renal function， adipokines before and after treatment， levels of inflammatory factors before and after treatment， and quality of life were compared between the two groups. Results The treatment effect of the observation group was 94.59%， which was higher than 75.68% of the control group（P<0.05）. The baseline renal functions of the observation group， such as fasting blood glucose， urea nitrogen， blood creatinine and 24 h urine protein， were （14.36±3.13）mmol/L， （14.23±4.22）mmol/L， （483.43±41.28）μmol/L， （2.38±1.02）mg， respectively， there were not statistically significant different from those of the control group（P>0.05）. Adiponectin， resistin， leptin and other adipokines in the observation group before and after treatment were （4.51±1.86）μg/mL， （1.52±1.92）μg/mL， （13.92±5.62）μg/mL， （7.23±4.32）μg/mL， （6.22±2.45）μg/mL， （2.84±2.33）μg/mL， respectively， compared with the control group after treatment（P<0.05）. The levels of IL-6， TNF-α and other inflammatory factors in the observation group before and after treatment were （213.63±37.42）pg/mL， （168.72±27.47）pg/mL， （153.62±41.33）pg/mL， and （99.44±22.17）pg/mL， respectively. Compared with the control group the difference was statistically significant（P<0.05）， after treatment， the mental health， physical health， and social life quality of the observation group were （23.9±4.53）points， （6.68±1.75）points， （8.37±2.16）points， respectively， which were higher than those of the control group（P<0.05）. Conclusion Different blood purification methods have different effects on the levels of serum adipokines and inflammatory factors in patients with diabetic nephropathy and chronic renal failure. Among them， continuous blood purification treatment is more effective.

[Key words] Blood purification; Diabetic nephropathy and chronic renal failure; Serum adipokines; Inflammatory factor levels

糖尿病肾病属于糖尿病患者比较常发的一种并发症，会导致患者出现终末期肾衰竭。由于糖尿病肾病慢性肾衰竭患者会出现肾脏系统紊乱以及肾功能异常等情况，所以身体会产生较多的毒素，从而增加并发症的发病率[1]。治疗糖尿病肾病慢性肾衰竭的主要方式就是要清除体内存在的毒素，促进肾脏代谢功能正常，临床上主要通过血液净化进行治疗[2]。经过大量的临床研究表明，血液净化能够消除血液内的毒素，对于治疗糖尿病肾病有着比较显著的效果。该次研究针对不同血液净化方式对糖尿病肾病慢性肾衰竭患者血清脂肪因子及炎性因子水平的影响进行分析，对此选择了2018年12月—2019年12月期间收治的糖尿病肾病慢性肾衰竭患者74例，现报道如下。……