中国血液净化

中国血液净化 ›› 2021, Vol. 20 ›› Issue (01): 34-37.doi: 10.3969/j.issn.1671-4091.2021.01.08

• 临床研究 • 上一篇    下一篇

不同血液净化方式对尿毒症患者血清Fetuin-A 及Apelin 表达的影响

孙建利1,杜金龙1,耿永芝1,关亚男1,李志军1,檀立端1   

  1. 1承德市中心医院急诊科
  • 收稿日期:2020-06-16 修回日期:2020-11-11 出版日期:2021-01-12 发布日期:2021-01-07
  • 通讯作者: 檀立端 asvqqf@163.com E-mail:hpkir3@163.com
  • 基金资助:
    河北省卫计委指导性课题(ZD2014133)

Effects of different blood purification methods on serum fetuin A and apelin levels in uremic patients

  1. 1Department of Emergency Medicine, Chengde Central Hospital, Chengde 067000, China
  • Received:2020-06-16 Revised:2020-11-11 Online:2021-01-12 Published:2021-01-07

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摘要： 【摘要】目的探讨不同血液净化方式对尿毒症患者血清胎球蛋白A(Fetuin-A)及脂肪因子(Apelin)表达的影响。方法选择承德市中心医院肾内科2017 年2 月～2019 年2 月收治的114 例尿毒症患者，随机数字表法分为高通量血液透析(high throughput hemodialysis，HFHD)组、血液透析滤过(hemodiafiltration，HDF)组、血液透析联合血液灌流(hemodialysis and hemoperfusion，HD+HP)组，每组38 例，治疗后，比较3 组患者血清Fetuin-A、Apelin、尿素氮(urea nitrogen，BUN)、血肌酐(serum creatinine,Scr)、Kt/V、血磷、血钙、钙磷乘积、血清β2-微球蛋白(β2-microglobulin,β2-MG)、甲状旁腺素(parathyroidhormone,PTH)水平以及治疗总有效率。结果治疗后HD+HP 组Fetuin-A 水平显著高于HFHD组并高于HDF 组(F=48.814,P＜0.001)，Apelin 水平显著低于HFHD 组并低于HDF 组(F=8.578,P＜0.001)；HD+HP 组BUN 水平低于HFHD 组和HDF 组(F=3.001,P=0.053)，Scr 水平高于HFHD 组和HDF 组(F=1.206,
P=0.303), 3 组Kt/V 指标比较差异不明显(F=1.942,P=0.148)；治疗后3 组患者血磷、钙磷乘积比较差异显著(F 值分别为14.144，11.590；P 值分别为＜0.001，＜0.001)，3 组血钙水平无显著差异(F=0.045，P=0.956)；HD+HP 组β2-MG 水平显著低于HFHD 组并低于HDF 组(F=355.820,P＜0.001)，PTH 水平显著低于HFHD 组并低于HDF 组(F=182.270,P＜0.001)；HD+HP 组总有效率为92.11%，HFHD 组总有效率为89.47%，HDF 组总有效率为63.16%，3 组间比较差异显著(χ2=34.100,P＜0.001)。结论HD+HP、HFHD 以及HDF 治疗尿毒症患者均展现出较好的治疗效果，能够提高血清Fetuin-A 水平并降低Apelin 水平，但HD+HP 血液透析效果较好，HFHD 位列其次，而HDF 稍弱。

关键词: 血液净化, 尿毒症, 血清Fetuin-A, 血清Apelin, 疗效

Abstract: 【Abstract】Objective To investigate the effects of different blood purification methods on serum fetuin A and apelin levels in uremic patients. Methods A total of 114 of uremic patients admitted to Chengde Central Hospital from February 2017 to February 2019 were recruited as the research subjects. They were assigned into high throughput hemodialysis (HFHD, n=38), hemodiafiltration (HDF, n=38), and hemodialysis plus hemoperfusion (HD+HP, n=38) by the random number list method. After the treatment, serum fetuin A and apelin, urea nitrogen (BUN), serum creatinine (Scr), Kt/V, serum phosphorus and calcium, calcium-phosphorus product, β2- microglobulin (β2-MG) and parathyroid gland (PTH) levels, and overall therapeutic efficiency
were compared among the three groups. Results After the treatment, serum fetuin A was significantly higher (F=48.814, P<0.001) and serum apelin was significantly lower (F=8.578, P <0.001) in HD+HP group than in HFHD group and HDF group; BUN was lower (F=3.001, P =0.053) and Scr was higher (F=1.206, P =0.303) in HD+HP group than in HFHD group and HDF group. There were no significant differences in Kt/V index among the three groups (F=1.942, P=0.148). After the treatment, serum phosphorus and phosphorus-calcium product were significantly different among the three groups (serum phosphorus: F=14.144, P=0.000; calcium-phosphorus product: F=11.590, P =0.000), but there were no significant differences in serum calcium level among the three groups (F=0.045, P =0.956); serum β2-MG and PTH were significantly lower in HD+ HP group than in HFHD group and HDF group (F=355.820, P<0.001; F=182.270, P<0.001). The overall effective rates were 92.11%, 89.47% and 63.16% in HD+HP group, HFHD group and HDF group respectively (χ2=34.100, P<0.001). Conclusion Uremic patients treated with either HD+HP, HFHD or HDF showed better effects, with the increase of serum fetuin A and decrease of serum apelin. HD+HP had the best blood purification effects, followed by HFHD and HDF methods.

Key words: Blood purification, Uremia, Serum fetuin A, serum apelin, Curative effect

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