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

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2组患者治疗前后高敏C反应蛋白(high sensitiving C-reactive protein,hs-CRP)、白介素6(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左心房前后径(LAD),左心室舒张期内径(LVEDd),左心室收缩期内径(LVEDs)左心室舒张期后壁厚度(LVPWT),室间隔厚度(IVST),左心室质量指数(LV-MI),左心室射血分数(LVEF),二尖瓣前向血流E峰与A峰比值(E/A),测量每分心输出量(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。

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

Objective To investigate the effects of high-flux hemodialysis on insulin resistance and cardiac function in non-diabetic patients on maintenance hemodialysis （MHD）. Methods We selected sixty patients, who underwent hemodialysis for more than one year and were in a stable clinical status without signs of acute infections or other progressive diseases. Patients were randomly divided into two groups, those treated with Fx 60 high-flux dialyzer （high-flux group） and those with F7 HPS low-flux dialyzer （routine hemodialysis group）, and they were treated 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）. Left atrial diameter （LAD）, left ventricular end- diastolic diameter （LVEDd）, left ventricular end-diastolic dimension （LVEDs）, interventricular septal thickness 0VST）, left ventricular posterior wall thickness （LVPWT）, left ventricular ejection fraction （LVEF）, left ventricular mass index （LVMI）, ratio of E/A, and cardiac output （CO） were measured by ultrasonic cardiography at the start and end of the study. Results In the patients on MHD, serum hsCRP, IL-6 and HOMA-IR were positively correlated to the values of LAD, LVEDd, LVEDs, IVST, LVPWT and LVMI （P〈0.05）, and negatively correlated to the values of LVEF, E/A and CO （P〈0.05）. HOMA-IR was positively correlated with hsCRP and IL-6 （P〈0.05）. After the treatment for 6 months, HOMA-IR, IL-6 and hsCRP were significantly decreased in the high-flux group （P〈 0.05） but not in the routine hemodialysis group. Conclusion This study demonstrates that high-flux dialyser provides a better effect on insulin resistance and cardiac functions than low-flux dialyser in non-diabetic patients on MHD.