中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (07): 353-357.doi: 10.3969/j.issn.1671-4091.2013.07.00

• 临床研究 • 上一篇    下一篇

高通量血液透析对非糖尿病尿毒症患者胰岛素抵抗和左室功能的影响

何萍1,张波2,邢昌赢3   

  1. 1. 江苏省扬州市江都人民医院
    2. 南京医科大学第一附属医院（江苏省人民医院）
    3. 南京医科大学第一附属医院
  • 收稿日期:2013-02-05 修回日期:2013-03-19 出版日期:2013-07-12 发布日期:2013-07-06
  • 通讯作者: 何萍 E-mail:wangwp0308@126.com

Effect of high-flux hemodialysis on insulin resistance and cardiac function in non-diabetic patients maintained on hemodialysis.

  • Received:2013-02-05 Revised:2013-03-19 Online:2013-07-12 Published:2013-07-06

RichHTML

0

PDF

534

摘要： 目的 观察高通量血液透析对非糖尿病维持性血液透析（MHD）患者胰岛素抵抗及心脏结构和功能的影响。方法 选择MHD患者60例，病情稳定，已排除急性感染及其他活动性疾病。随机分为高通量透析组和常规血液透析组，每组30例。治疗6个月，分别观察两组患者治疗前后hsCRP、IL-6和稳态模型胰岛素抵抗指数（HOMA-IR），并应用心脏超声心动图测定患者LAD,LVEDd,LVEDs, LVPWT, IVST,LVMI和LVEF，E/A,CO等。结果 hsCRP、HOMA-IR、IL-6分别与LAD,LVEDd,LVEDs,IVST,LVPWT,LVMI呈正相关（P <0.05），与LVEF、E/A、CO呈负相关（P <0.05）。HOMA-IR与hsCRP、IL-6相互之间呈正相关（P <0.05）。高通量血液透析组hsCRP、IL-6 和HOMA-IR与治疗前相比显著下降，差异有统计学意义，而普通血液透析组治疗前后差异无统计学意义。结论 MHD患者存在微炎症状态，高通量血液透析较低通量透析能明显改善非糖尿病维持性血液透析患者胰岛素抵抗，并改善了心脏功能。

关键词: 血液透析, 高通量, 胰岛素抵抗

Abstract: Objective To investigate the effects of high-flux hemodialysis on insulin resistance and cardiac function in non-diabetic patients maintained on hemodialysis.Methods Sixty patients with maintenance hemodialysis were selected,who had undergone hemodialysis for more than one year and were in a stable clinic status without signs of acute infections or other progressive diseases. These patients were divided into two groups.Patients in each group were treated using either Fx 60(high-flux dialyzer) or F7 HPS(low-flux dialyzer) for 6 months. Serum IL-6 and hsCRP were measured at the start and end of the study.Insulin resistance was assessed by using the homeostasis model assessment(HOMA-IR).The left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDd), left ventricular end-diastolic dimension(LVEDs),interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT) and left ventricular ejection fraction(LVEF), left ventricular mass index(LVMI),ratio of E/A,the cardiac output(CO)were measured by ultrasonic cardiography at the start and end of the study. Results In patients with maintenance hemodialysis ,the average serum hsCRP、IL-6 and HOMA-IR were positively correlated with the values of LAD,LVEDd,LVEDs,IVST,LVPWT and LVMI（P <0.05）,but negatively correlated with the value of LVEF，E/A and CO（P <0.05）.After 6 month observation,the levels of HOMA-IR、IL-6 and hsCRP in high-flux group were significantly decreased according to HD group （P <0.05）. Conclusion This study demonstrates that high-flux dialyser provides a better effect on insulin resistance than does the low-flux dialyser for non-diabetic patients maintained on hemodialysis.

Key words: hemodialysis, High-flux dialyser, Insulin resistance