【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。
【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.
[1]Raghavan R , Eknoyan G . Uremia: A historical reappraisal of what happened[J]. Clinical nephrology, 2018, 89(5):401.
[2]Liang H , Wang D , Che G , et al. Evaluation of carotid artery elasticity in patients with uremia by echo tracking[J]. Journal of Medical Ultrasonics, 2018, 45(4):1-6.
[3]Tabriziani H , Lipkowitz M S , Vuong N . Chronic kidney disease, kidney transplantation and oxidative stress: a new look to successful kidney transplantation[J]. Clinical Kidney Journal, 2018, 11(1):130-135.
[4]DENG Jie, QIN Qiu-yi, JIANG Mei-ling. Influence of cognitive emotion and behavioral nursing intervention on end-stage renal failure patients receiving hematodialysis[J]. nursing practice & research, 2017,08(5):473.
[5]纪德华.试论血液灌流联合高容量血液滤过治疗ARDS的价值[J]. 中国继续医学教育, 2018, 010(009):72-74.
[6]Morena M , Jaussent A , Chalabi L , et al. Treatment tolerance and patient-reported outcomes favor online hemodiafiltration compared to high-flux hemodialysis in the elderly[J]. Kidney International, 2017, 91(6):1495-1509.
[7]Suni Z , Dan L , Wenjun W . Clinical diagnostic value of serum Fetuin-A in patients with chronic obstructive pulmonary disease coexist with cardiovascular disease[J]. journal of modern medicine & health, 2018,04(9):563.
[8]Lv S Y , Cui B , Chen W D , et al. Apelin/APJ system – A key therapeutic target for liver disease[J]. Oncotarget, 2017, 8(67):112145-112151.
[9]沈君怡, 王卿炜. 术前MRI检查对尿毒症继发性甲状旁腺功能亢进症的应用价值[J]. 中国卫生标准管理, 2018, 009(004):112-113.
[10]庄新鸿, 庄乙君, 杜永国,等. 肺炎衣原体感染对尿毒症患者心血管的影响[J]. 中华医院感染学杂志, 2018, 028(001):47-50.
[11]邓悟, 杨凡, 马桂芬,等. 小儿溶血尿毒症综合征24例临床分析[J]. 四川大学学报(医学版), 2018, 49(03):182-184.
[12]余燕婷, 高占辉, 赵刘兵,等. 经皮腔内血管成形术与手术治疗血液透析患者自体动静脉内瘘狭窄的临床效果比较[J]. 医学研究生学报, 2017,01(30):1308.
[13]Xiao-fang Han,Xin-xiu Zhang,Ke-mei Liu,Qiu Zhang. Apelin-13 deficiency alters cortical bone geometry, organic bone matrix, and inhibits Wnt/β-catenin signaling[J]. General and Comparative Endocrinology,2018,05(24):112-114.
[14]Cai Read,Peiran Yang,Rhoda E. Kuc,Duuamene Nyimanu,Thomas L. Williams,Robert C. Glen,Lucy J. Holt,Haren Arulanantham,Andrew Smart,Anthony P. Davenport,Janet J. Maguire. Apelin peptides linked to anti‐serum albumin domain antibodies retain affinity in vitro and are efficacious receptor agonists in vivo[J]. Basic & Clinical Pharmacology & Toxicology,2020,126(10):96-103.
[15]曹有文,陈红,钟玉华.血液透析联合血液灌流治疗对尿毒症患者血清BUN、PTH、Cr和β2-MG水平的影响[J].当代医学,2019,25(24):60-63.
[16]郝少龙, 刘新承, 马纪红,等. 甲状腺术后引流液PTH监测的临床意义[J]. 中华内分泌外科杂志, 2018, 012(001):39-42.
[17]赵璇,李学刚,孙云,肖合存,蒋雅丽.连续血液净化与普通血液透析对老年急性肾衰竭患者血Scr、BUN及MAP水平的影响[J].中国老年学杂志,2018,38(03):649-651.
[18]郭锋伟,陈强,郝军军.血清胱抑素C与肌酐水平评估不停跳冠脉旁路移植术后急性肾损伤的临床意义[J].现代医学,2018,46(03):263-267.
[19]Yin P , Li J , Song Y . Soluble transferrin receptor as a marker of erythropoiesis in patients undergoing high-flux hemodialysis[J]. Bosnian Journal of Basic Medical Sciences, 2017, 17(4):1972.
[20]董艳华,王琳琳,朱桂栋.不同通透量血液透析对老年尿毒症患者甲状旁腺激素及钙、磷代谢的影响[J].临床误诊误治,2018,31(05):94-98.
[21]王宇静.三种不同血液净化方式对尿毒症患者血清中β2-MG钙磷浓度及甲状旁腺激素水平的影响[J].河北医学,2019,25(08):1295-1299.
[22]袁茜,唐南,彭侃夫.尿毒症血液透析患者血清Vaspin、Apelin、Chemerin水平与营养代谢的相关性[J].中国血液净化,2019,18(11):755-759.
