血液透析联合血液灌流治疗对终末期糖尿病肾病患者胰岛素抵抗与营养状态的影响效果分析

摘要

Objective To explore the effect of hemodialysis combined with hemoperfusion therapy on ESDN patients’insulin resistance and nutritional status.Methods Totally 126 cases of ESDN patients treated in The Fourth Renmin Hospital of Hengshui city were ran-domized into hemodialysis combined with hemoperfusion treatment group (short for observation group)and hemodialysis combined with hemodiafiltration treatment group (short for control group),63 cases in each group.Patients’insulin resistance status (FBG,FINS,Ho-ma-IR),nutritional status evaluation (SGA,BMI,TSF)and immune factor determination (CRP,TNF-a,IL-6)were observed before and after treatment.Results There were no significant differences in FBG,FINS,Homa-IR,SGA,BMI,TSF,CRP,TNF-αand IL-6 in both groups before treatment(P >0.05),while after treatment,FBG、FINS、Homa-IR,CRP,TNF-αand IL-6 levels all obviously de-creased in observation group,which indicated statistically significant difference (P <0.05 ).Conclusions Hemodialysis combined with hemoperfusion therapy can effectively improve ESDN patients’insulin resistance and nutritional status,remove inflammatory medi-ators,which is worthy of application in clinic.%目的：探讨血液透析联合血液灌流治疗对终末期糖尿病肾病（ESDN）患者胰岛素抵抗与营养状态的影响效果。方法126例 ESDN 患者，按照随机数字表法分为血液透析联合血液灌流治疗组（简称观察组）以及血液透析联合血液透析滤过治疗组（简称对照组），每组各63例。观察治疗前后两组患者的胰岛素抵抗情况[葡萄糖（FBG）、胰岛素（FINS）、胰岛素抵抗指数（Homa-IR）]、营养状态评估[主观综合性营养评估（SGA）、体重指数（BMI）、肱三头肌皮褶厚度（TSF）]以及免疫因子测定[C 反应蛋白（CRP）、肿瘤坏死因子（TNF-a）、白介素-6（IL -6）]。结果治疗前，两组患者的 FBG、FINS、Homa-IR、SGA、BMI、TSF、CRP、TNF-a 以及 IL-6比较，均差异无统计学意义（P ＞0．05）；治疗后，与对照组比较，观察组患者的 FBG、FINS、Ho-ma-IR、CRP、TNF-a 以及 IL-6水平均降低明显，SGA、BMI 以及 TSF 均升高明显，差异有统计学意义（P ＜0．05）。结论血液透析联合血液灌流治疗可有效改善 ESDN 患者胰岛素抵抗现象及营养状态，清除炎症介质，具有较好的临床推广价值。