血液透析滤过对糖尿病肾衰竭患者微炎性反应和胰岛素抵抗的影响

目的:观察血液透析滤过对糖尿病维持性血液透析患者微炎性反应和胰岛素抵抗的影响。方法:选择糖尿病肾病血液透析患者56例,病情稳定,已排除急性感染及其他活动性疾病。随机分为常规血液透析组(27例)和血液透析滤过组(29例)。治疗6个月,分别观察两组患者治疗前后hsCRP、IL-6、甲状旁腺素(PTH)和稳态模型胰岛素抵抗指数(HOMA-IR)。结果:HOMA-IR与hsCRP、IL-6相互之间呈正相关(P<0.05)。血液透析滤过组hsCRP、IL-6、PTH和HOMA-IR与治疗前相比,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(P>0.05)。结论:MHD患者存在微炎性反应状态和胰岛素抵抗,血液透析滤过较低通量透析能明显改善糖尿病维持性血液透析患者微炎性反应状态和胰岛素抵抗。

Effect of hemodiafiltration on inflammation and insulin resistance in diabetic kidney disease patients with maintenance hemodialysis

Objective To study the effects of hemodiafihration on inflammation and insulin resistance in diabetic kidney disease patients with maintenance hemodialysis. Method Fifty- six diabetic patients with maintenance hemodialysis were selected,who had undergone hemodialysis for more than three months and were in a stable clinic status without signs of acute itffections or other progressive disea- ses. These patients were divided into two groups：the HD group（ treated with HD, n = 27） and the HDF group（ treated with HDF in addition to HD,n =29）. Patients in each group were treated for 6 months. Serum IL-6,hsCRP and PTH were measured at the start and end of the study. Insulin resistance was assessed by using the homeostasis model assessment（ HOMA - IR）. Results In diabetic patients with mainte- nance hemodialysis,after 6 month observation ,the levels of HOMA -IR、IL -6 hsCRP and PTH in HDF group wcrc significantly decreased according to HD group （P 〈0.05）. Conclusion This study demonstrates that HDF provides a better effect on inflammation and insulin re- sistance than does HD for diabetic patients maintained on hemodialysis.