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目的研究高通量血液透析治疗糖尿病肾病(DN)的临床疗效及对患者胰岛素抵抗(IR)的影响。方法选取2013年1月-2014年1月期间收治的符合纳入标准的DN患者共计96例。随机分成研究组和对照组,每组48例。对照组给予低通量血液透析,研究组给予高通量血液透析。分别于治疗前及治疗后半年时,采集两组患者临床肾功能以及炎性指标、脂代谢相关指标情况、糖代谢相关指标水平,计算出IR指数(HOMA-IR),并进行比较。结果两组患者治疗前后Kt/V均无显著变化,差异均无统计学意义(P>0.05)。治疗后血肌酐水平均显著低于治疗前,研究组治疗后C反应蛋白、白细胞介素-6及肿瘤坏死因子α均显著低于治疗前及对照组治疗后,差异均有统计学意义(P<0.05)。研究组患者治疗后HOMA-IR及空腹胰岛素水平均显著低于治疗前及对照组治疗后,差异均有统计学意义(P<0.05)。两组患者治疗前后空腹血糖及糖化血红蛋白水平无显著变化,差异均无统计学意义(P>0.05)。结论高通量血液透析治疗DN临床疗效显著,可有效清除患者机体内中、大分子型炎性介质,缓解微炎症状态,能改善IR状况并纠正患者脂代谢异常,值得临床推荐。
Objective To study the clinical effect of high-flux hemodialysis on diabetic nephropathy (DN) and its effect on insulin resistance (IR). Methods A total of 96 DN patients who met the inclusion criteria were selected from January 2013 to January 2014. Randomly divided into study group and control group, 48 cases in each group. The control group was given low-flux hemodialysis, and the study group was given high-flux hemodialysis. Clinical indexes of renal function, inflammation, lipid metabolism, and glucose metabolism were collected before treatment and six months after treatment respectively. HOMA-IR was calculated and compared. Results There was no significant difference in Kt / V between the two groups before and after treatment, with no significant difference (P> 0.05). After treatment, serum creatinine levels were significantly lower than before treatment, the study group after treatment, C-reactive protein, interleukin -6 and tumor necrosis factor alpha were significantly lower than before treatment and control group after treatment, the difference was statistically significant (P <0.05). The levels of HOMA-IR and fasting insulin in study group after treatment were significantly lower than those before treatment and control group after treatment, the difference was statistically significant (P <0.05). There was no significant difference in fasting blood glucose and glycosylated hemoglobin level between the two groups before and after treatment (P> 0.05). Conclusion High-throughput hemodialysis treatment of DN significant clinical effect, which can effectively clear the body of patients with medium and macromolecular inflammatory mediators, relieve micro-inflammatory state, can improve the IR status and correct the abnormal lipid metabolism in patients, it is clinically recommended.