HD+HP对老年终末期肾病动脉粥样硬化及心血管并发症的预防效果

doi:10.3969/j.issn.10073205.2017.08.005

河北医科大学学报

HD+HP对老年终末期肾病动脉粥样硬化及心血管并发症的预防效果

1.广东省惠州市中医医院内科，广东惠州 516001;2.广州医科大学第二附属医院重症医学科，广东广州 510000

出版日期:2017-08-25 发布日期:2017-08-09
作者简介:刘汉伟（1967-），男，广东惠东人，广东省惠州市中医医院副主任医师，医学学士，从事肾病、老年病、血液净化技术、重症医学研究。
基金资助:
国家自然科学基金资助项目（81201453）

Preventive effect of HD+HP on atherosclerosis and cardiovascular complications in elderly patients with endstage renal disease#br#

1.Department of Interanl Medicine, Huizhou Hospital of Traditional Chinese Medicien, Guangdong
Province, Huizhou 516001, China; 2.Department of Critical Care Medi Cine, the Second
Affiliated Hospital of Guangzhou Medical University, Guangdong Province,
Guangzhou 510260, China

Online:2017-08-25 Published:2017-08-09

摘要/Abstract

摘要： ［摘要］〓
〖HTH〗目的〖HTSS〗〖KG*2〗探讨血液透析（hemodialysis,HD）联合血液灌流（hemoperfusion,HP）对老年终末期肾病（end stage renal disease,ERSD）患者动脉粥样硬化及心血管并发症的预防效果。
〖HTH〗方法〖HTSS〗〖KG*2〗将行维持性HD的60例老年ESRD患者按随机数字表法分为2组各30例。观察组接受HD+HP，对照组仅行HD。治疗前、治疗后6个月，采集患者空腹静脉血检测对比2组载脂蛋白C3（apolipoprotein C3,ApoC3）、高密度脂蛋白（high density lipoprotein,HDL）、低密度脂蛋白（low density lipoprotein,LDL）、三酰甘油（triglyceride,TG）、总胆固醇（total cholesterol,TC）、C反应蛋白（Creactive protein,CRP）、血红蛋白（hemoglobin,Hb）、白蛋白（albumin,ALB）、白细胞介素6（interleukin6,IL6）、白细胞介素8（interleukin8,IL8）、肿瘤坏死因子α（tumor necrosis factorα,TNFα）水平，检测患者颈动脉内中膜厚度（carotid intimamedia thickness,CIMT），统计心血管并发症发生率。
〖HTH〗结果〖HTSS〗〖KG*2〗①治疗后6个月：对照组IL6、IL8明显下降（P＜005）；观察组IL6、IL8、ApoC3、TG、CRP明显下降，HDL、ALB明显上升（P＜005）；观察组IL6、IL8下降程度明显大于对照组，差异有统计学意义（P＜005）。②治疗后6个月：对照组CIMT明显上升，与治疗前比较差异有统计学意义（P＜005），而观察组CIMT未见明显变化；非条件Logistic回归分析显示ApoC3、TG、IL6和CRP是CIMT增厚的独立危险因素，HDL是CIMT增厚的独立保护因素（P＜005）。③观察组心肌损害及心力衰竭发生率均明显低于对照组，差异有统计学意义（P＜005）。
〖HTH〗结论〖HTSS〗〖KG*2〗HD+HP有助于抑制老年ERSD动脉粥样硬化的形成，这可能与其对ApoC3、TG及CRP的抑制作用有关，有助于降低多种心血管并发症的发生率。

关键词: 肾病, 肾透析, 灌流, 动脉粥样硬化, 心血管并发症

Abstract: ［Abstract］ Objective〖HTSS〗〓To investigate the preventive effect of hemodialysis(HD) combined with hemoperfusion(HP) on atherosclerosis and cardiovascular complications in elderly patients with end stage renal disease(ERSD).
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Sixty cases of elderly patients with ESRD treated by maintenance hemodialysis in our hospital were included and randomly divided into 2 groups, with 30 cases in each group, by random number table. The observation group was treated with HD+HP, while the control group was treated with sole HD. Fasting blood samples were collected before and 6 months after treatment, in order to detect and compare the level of apolipoprotein C3(ApoC3), high density lipoprotein(HDL),low density lipoprotein(LDL), triglyceride(TG), total cholesterol(TC), Creactive protein(CRP), hemoglobin(Hb）, albumin(ALB), interleukin6(IL6), interleukin8(IL8), tumor necrosis factorα(TNFα), carotid intimamedia thickness(CIMT)of patients were also detected. The incidence of cardiovascular complications were recorded.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓①6 months after treatment, IL6 and IL8 in the control group were significantly decreased (P＜005). While IL6, IL8, ApoC3, TG and CRP in the observation group were decreased significantly, HDL and ALB in the observation group were increased significantly(P＜005). The decreasing of IL6 and IL8 in the observation group were more obvious than in the control group, the differences were statistically significant(P＜005). ②6 months after treatment, CIMT in the control group was increased significantly(P＜005) compared with before treatment. While CIMT in the observation group did not change obviously. Nonconditional logistic regression analysis showed that APOC3, TG, IL6 and CRP were independent risk factors for CIMT thickening, and HDL was an independent protective factor for CIMT thickening(P＜005).③The incidence rate of myocardial injury and heart failure in the observation group were significantly lower than those in the control group, the differences were statistically significant (P＜005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓HD+HP can inhibit the formation of atherosclerosis in elderly patients with end stage renal disease, which may be related to the inhibition of ApoC3, TG and CRP. This will help to reduce the incidence of various cardiovascular complications.

Key words: nephrosis； renal dialysis, perfusion, atherosclerosis, cardiovascular complications

刘汉伟1，张振辉2，唐纪文1，邹丽娥1，王春凤1. HD+HP对老年终末期肾病动脉粥样硬化及心血管并发症的预防效果[J]. 河北医科大学学报, doi: 10.3969/j.issn.10073205.2017.08.005.

LIU Hanwei1， ZHANG Zhenhui2， TANG Jiwen1， ZOU Lie1， WANG Chunfeng1. Preventive effect of HD+HP on atherosclerosis and cardiovascular complications in elderly patients with endstage renal disease#br#[J]. Journal of Hebei Medical University, doi: 10.3969/j.issn.10073205.2017.08.005.

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HD+HP对老年终末期肾病动脉粥样硬化及心血管并发症的预防效果

Preventive effect of HD+HP on atherosclerosis and cardiovascular complications in elderly patients with endstage renal disease#br#

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