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中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2021, Vol. 15 ›› Issue (12) : 1009 -1015. doi: 10.3877/cma.j.issn.1674-0785.2021.12.018

临床研究

高通血液透析联合生血宁对维持性血液透析老年患者肾性贫血及氧化应激的影响
马涛1, 李秀勇2,†(), 王丽3, 刘正亮1, 张甜甜1, 王瑞雪1, 张磊1, 王心亮1   
  1. 1. 236000　安徽阜阳，阜阳市第二人民医院血液净化中心
    3. 515041　广东深圳，深圳市龙华新区人民医院肾内科
  • 收稿日期:2021-05-20 出版日期:2021-12-15
  • 通信作者: 李秀勇
  • 基金资助:
    阜阳市卫生和计划生育委员会项目(2016-49)

Effects of high-flux hemodialysis combined with Shengxuening on renal anemia and oxidative stress in elderly patients with maintenance hemodialysis

Tao Ma1, Xiuyong Li2,†(), Li Wang3, Zhengliang Liu1, Tiantian Zhang1, Ruixue Wang1, Lei Zhang1, Xinliang Wang1   

  1. 1. Blood Purification Center, No. 2 People' s Hospital of Fuyang City, Fuyang 236000, China
    2. Department of Nephrology, Shenzhen Longhua New District People' s Hospital, Shenzhen 515041, China
  • Received:2021-05-20 Published:2021-12-15
  • Corresponding author: Xiuyong Li
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引用本文：

马涛, 李秀勇, 王丽, 刘正亮, 张甜甜, 王瑞雪, 张磊, 王心亮. 高通血液透析联合生血宁对维持性血液透析老年患者肾性贫血及氧化应激的影响[J]. 中华临床医师杂志(电子版), 2021, 15(12): 1009-1015.

Tao Ma, Xiuyong Li, Li Wang, Zhengliang Liu, Tiantian Zhang, Ruixue Wang, Lei Zhang, Xinliang Wang. Effects of high-flux hemodialysis combined with Shengxuening on renal anemia and oxidative stress in elderly patients with maintenance hemodialysis[J]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(12): 1009-1015.

目的

研究高通血液透析（HFHD）联合生血宁对维持性血液透析（MHD）老年患者肾性贫血及氧化应激的影响。

方法

选取2017年1月至2019年12月于阜阳市第二人民医院治疗的老年MHD肾性贫血患者100例，随机分为观察组和对照组，各50例。所有患者均采用HFHD，同时给予重组人促红素（rHuEPO）皮下注射，在此基础上观察组和对照组分别给予生血宁和琥珀酸亚铁片口服，疗程3个月。比较2组治疗前后贫血状态［血红蛋白（Hb）、血细胞比容（Hct）和血清铁蛋白（SF）］、营养水平［白蛋白（Alb）、转铁蛋白（TRF）、血清总蛋白（TP）］、微炎症状态［高敏C-反应蛋白（hs-CRP）、白细胞介素-6（IL-6）和肿瘤坏死因子（TNF-α）］、氧化应激水平［血清超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-Px）、丙二醛（MDA）］、心血管指标［B型脑钠肽（BNP）、平均动脉压（MAP）、血管外肺水指数（EVLWI）］和肝肾功能［血肌酐（Scr）、β2微球蛋白（β2-MG）、谷丙转氨酶（ALT）］变化，同时观察药物不良反应发生情况。

结果

与治疗前相比，治疗后2组Hb、Hct和SF水平均明显升高（P＜0.05），但2组间比较各指标差异无统计学意义（P＞0.05）。与治疗前相比，治疗后观察组ALB、TRF和TP水平明显升高（P＜0.05），对照组各指标无明显变化（P＞0.05），且观察组治疗后ALB、TRF和TP水平高于对照组，差异有统计学意义（P＜0.05）。与治疗前相比，治疗后2组hs-CRP、IL-6和TNF-α水平均明显降低（P＜0.05），且观察组hs-CRP、IL-6和TNF-α水平低于对照组，差异有统计学意义（P＜0.05）。与治疗前相比，治疗后2组SOD和GSH-Px水平均明显升高（P＜0.05），MDA水平明显降低（P＜0.05），且观察组治疗后SOD和GSH-Px水平高于对照组，MDA水平低于对照组，差异有统计学意义（P＜0.05）。与治疗前相比，治疗后2组BNP水平明显降低（P＜0.05），MAP和EVLWI均未见明显变化（P＞0.05），且观察组治疗后BNP水平低于对照组，差异有统计学意义（P＜0.05）。与治疗前相比，治疗后2组Scr和β2-MG水平均明显降低（P＜0.05），ALT水平未见明显变化（P＞0.05），2组间比较各指标差异无统计学意义（P＞0.05）。观察组肺部感染（4.35% vs 8.51%）、消化道不适发生率（6.52% vs 21.28%）均低于对照组，差异有统计学意义（P＜0.05）。

结论

HFHD联合生血宁治疗老年MHD患者肾性贫血可有效改善患者贫血状态、营养水平、微炎症状态和氧化应激，对防止心血管疾病发生具有积极作用，临床效果和安全性均值得肯定。

关键词: 维持性血液透析, 肾性贫血, 氧化应激, 高通量血液透析, 生血宁
Objective

To investigate the effects of high-flux hemodialysis (HFHD) combined with Shengxuening on renal anemia and oxidative stress in elderly patients with maintenance hemodialysis (MHD).

Methods

A total of 100 elderly patients with MHD and renal anemia who were treated at Fuyang Second People's Hospital from January 2017 to December 2019 were randomly divided into an observation group and a control group, with 50 cases each. They were all treated with HFHD, and human erythropoietin (rHuEPO) was injected subcutaneously. On this basis, the observation group and the control group were orally given Shengxuening and ferrous succinate tablets, respectively, and the course of treatment was 3 months. The anemia status [hemoglobin (Hb), hematocrit (Hct), and serum ferritin (SF)], nutritional level [albumin (Alb), transferrin (TRF), and total serum protein (TP)], micro-inflammatory state [high sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α)], oxidative stress level [serum superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and serum malondialdehyde (MDA)], cardiovascular indicators [B-type brain natriuretic peptide (BNP), mean arterial pressure (MAP), and extravascular lung water index (EVLWI)], and liver and kidney function [creatinine (Scr), β2 microglobulin (β2-MG), and alanine aminotransferase (ALT)] were compared between the two groups, and the occurrence of adverse drug reactions was observed.

Results

After treatment, the levels of Hb, Hct, and SF in the two groups were significantly increased compared with those before treatment (P＜0.05), but there was no statistical significance in each index between the two groups (P＞0.05). The levels of ALB, TRF, and TP in the observation group were significantly increased after treatment (P＜0.05), while no significant changes were observed in the control group (P＞0.05); the levels of ALB, TRF, and TP in the observation group were higher than those in the control group (P＜0.05). The levels of hS-CRP, IL-6, and TNF-α in both groups were significantly decreased after treatment (P＜0.05), and the levels of hS-CRP, IL-6, and TNF-α in the observation group were significantly lower than those in the control group (P＜0.05). SOD and GSH-Px levels in both groups were significantly increased after treatment (P＜0.05), while MDA levels were significantly decreased (P＜0.05). SOD and GSH-Px levels in the observation group were significantly higher than those in the control group, while MDA level was significantly lower than that in the control group (P＜0.05). BNP levels in both groups were significantly decreased after treatment (P＜0.05), while MAP and EVLWI showed no significant changes (P＞0.05); BNP level in the observation group was significantly lower than that of the control group (P＜0.05). The levels of Scr and β 2-MG in both groups were significantly decreased after treatment (P＜0.05), while the level of ALT was not significantly changed (P＞0.05); there was no statistical significance in these indexes between the two groups (P＞0.05). The incidence of pulmonary infection (4.35% vs 8.51%) and digestive tract discomfort (6.52% vs 21.28%) in the observation group was significantly lower than that of the control group (P＜0.05).

Conclusion

HFHD combined with Shengxuening in the treatment of renal anemia in elderly patients with MHD can effectively improve the anemia status, nutritional level, micro-inflammatory status, and oxidative stress, which has positive effects in preventing the occurrence of cardiovascular disease. This combination therapy has appreciated clinical effects and safety.

Key words: Maintenance hemodialysis, Renal anemia, Oxidative stress, High-flux hemodialysis, Shengxuening
表1 2组维持性血液透析患者临床基本资料比较
组别 例数 性别 年龄（岁，
x¯
±s）		 BMI（kg/m2，
x¯
±s）		 透析龄（年，
x¯
±s）		 CKD分期（例） 原发肾脏疾病（例）
男 女 3期 4期 5期 慢性肾炎 高血压肾病 糖尿病肾病 其他
观察组 46 25 21 76.89±10.24 21.07±3.18 2.74±0.85 12 18 16 29 6 8 3
对照组 47 20 27 78.46±10.62 20.83±2.96 2.56±0.91 14 20 13 25 7 10 5
统计值 χ2=1.295 t=0.726 t=0.376 t=0.985 χ2=0.559 χ2=1.085
P值 0.255 0.470 0.707 0.237 0.756 0.781
表2 2组维持性血液透析患者治疗前后贫血相关指标比较（
xˉ
±s）
组别 例数 Hb（g/L） Hct（%） SF（μg/L）
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 46 74.26±12.09 95.38±10.45a 28.61±3.04 30.42±2.39a 136.47±25.83 264.58±37.14a
对照组 47 73.85±10.72 92.67±12.94a 28.19±2.87 30.75±2.16a 134.92±26.05 261.89±32.45a
t值 0.173 1.109 0.685 1.419 0.288 0.372
P值 0.863 0.270 0.494 0.159 0.774 0.711
表3 2组维持性血液透析患者治疗前后营养水平比较（
xˉ
±s）
组别 例数 ALB（g/L） TRF（g/L） TP（g/L）
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 46 26.31±4.85 29.76±4.13a 1.24±0.37 1.49±0.36a 52.13±6.47 56.82±7.61a
对照组 47 26.94±5.03 27.40±4.68 1.28±0.35 1.32±0.41 50.98±6.25 53.29±7.48
t值 0.615 2.576 0.536 2.123 0.872 2.256
P值 0.540 0.012 0.594 0.037 0.386 0.027
表4 2组维持性血液透析患者治疗前后炎症状态比较（
xˉ
±s）
组别 例数 hs-CRP（mg/L） IL-6（ng/L） TNF-α（μg/L）
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 46 12.98±3.17 9.34±2.19a 142.76±28.35 106.24±17.68a 1.29±0.35 0.93±0.21a
对照组 47 13.25±3.46 10.39±2.63a 139.84±27.91 118.52±19.43a 1.26±0.31 1.07±0.24a
t值 0.392 2.090 0.501 3.186 0.438 2.991
P值 0.696 0.039 0.618 0.002 0.663 0.004
表5 2组维持性血液透析患者治疗前后氧化应激指标比较（
xˉ
±s）
组别 例数 SOD（ku/L） MDA（mmol/L） GSH-Px（U/L）
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 46 71.45±10.89 89.72±13.56a 6.34±1.39 5.13±1.26a 59.61±8.79 68.92±7.58a
对照组 47 70.63±12.37 82.16±14.28 6.07±1.42 5.68±1.35 60.47±9.24 64.13±8.35a
t值 0.339 2.618 0.583 2.030 0.459 2.895
P值 0.735 0.010 0.561 0.045 0.647 0.005
表6 2组维持性血液透析患者治疗前后心血管指标比较（
xˉ
±s）
组别 例数 BNP（ng/L） MAP（mmHg） EVLWI（ml/kg）
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 46 397.82±94.06 246.58±61.39* 78.23±9.14 79.41±9.34 12.05±2.73 12.96±2.47
对照组 47 394.15±92.73 290.62±72.45* 76.82±9.36 80.25±9.78 11.64±2.89 13.28±2.54
t值 0.189 3.159 0.735 0.423 0.703 0.616
P值 0.850 0.002 0.464 0.673 0.484 0.540
表7 2组维持性血液透析患者治疗前后肝肾功能比较（
xˉ
±s）
组别 例数 Scr（μmol/L） β2-MG（mg/L） ALT（U/L）
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 46 749.35±132.68 528.14±109.65a 27.46±8.19 21.54±6.28a 17.43±4.86 16.98±4.35
对照组 47 754.06±135.43 534.27±106.82a 27.95±8.37 21.03±5.96a 17.09±4.52 17.24±4.61
t值 0.169 0.273 0.285 0.402 0.349 0.312
P值 0.866 0.785 0.776 0.689 0.728 0.756
1
裴小华, 柏云, 赵卫红. 老年3b期或以上慢性肾脏病患者的管理2016欧洲最优肾脏临床实践组织临床实践指南解读 [J]. 中华老年医学杂志, 2018, 37(5): 492-495.
2
Cherng YG, Lin CS, Shih CC, et al. Stroke risk and outcomes in patients with chronic kidney disease or end-stage renal disease: Two nationwide studies [J]. PLoS One, 2018, 13(1): e0191155.
3
Elghoroury EA,Fadel FI, Elshamaa MF, et al. Klotho G-395A gene polymorphism: impact on progression of end-stage renal disease and development of cardiovascular complications in children on dialysis [J]. Pediatr Nephrol, 33(6): 1019-1027.
4
Li Y, Shi H, Wang WM, et al. Prevalence, awareness, and treatment of anemia in Chinese patients with nondialysis chronic kidney disease: First multicenter, cross-sectional study [J]. Medicine(Baltimore), 2016, 95(24): e3872.
5
Morena M, Creput C, Bouzernidj M, et al. Randomised trial on clinical performances and biocompatibility of four high-flux hemodialyzers in two mode treatments: hemodialysis vs post dilution hemodiafiltration [J]. Sci Rep, 2019, 9(1): 18265.
6
汤晓静, 严海东, 张黎明, 等. 生血宁片对非透析慢性肾脏病肾性贫血患者的临床疗效 [J]. 中成药, 2019, 41(2): 316-321.
7
Leimbach T, Kron J, Czerny J, et al. Hemodialysis in patients over 80 years [J]. Nephron, 2015, 129(3): 214-218.
8
中华医学会. 《临床诊疗指南(肾脏病学分册)》 [M]. 北京: 人民卫生出版社, 2011: 39-43.
9
中华医学会肾脏病学分会肾性贫血诊断和治疗共识专家组. 肾性贫血诊断与治疗中国专家共识(2018修订版) [J]. 中华肾脏病杂志, 2018, 34(11): 860-866.
10
Fukao W, Hasuike Y, Yamakawa T, et al. Oral versus intravenous iron supplementation for the treatment of iron deficiency anemia in patients on maintenance hemodialysis-effect on fibroblast growth factor-23 metabolism [J]. J Ren Nutr, 2018, 28(4): 270-277.
11
黄飞鸿, 朱林杰, 李迪迪, 等. 生血宁片对环磷酰胺致贫血小鼠的作用及机制 [J]. 中成药, 2016, 38(6): 1205-1210.
12
Toyoda K, Kuragano T, Kawada H, et al. Effect of progression in malnutrition and inflammatory conditions on adverse events and mortality in patients on maintenance hemodialysis [J]. Blood Purif, 2019, 47(2): 3-11.
13
Sahin S,Tasar PT,Simsek H,et al. Prevalence of anemia and malnutrition and their association in elderly nursing home residents [J]. Aging Clin Exp Res, 2016, 28(5): 857-862.
14
Bahrainwala J, Berns JS. Diagnosis of iron-deficiency anemia in chronic kidney disease [J]. Semin Nephrol, 2016, 36(2): 94-98.
15
Kara AV, Soylu YE. The relationship between vitamin D and inflammatory markers in maintenance hemodialysis patients [J]. Int Urol Nephrol, 2019, 51(9):1659-1665.
16
Łukaszyk E, Łukaszyk M, Koc-Żórawska E, et al. Iron status and inflammation in early stages of chronic kidney disease [J]. Kidney Blood Press Res, 2015, 40(4): 366-373.
17
杨建新, 杨娟. 高通量血液透析与常规血液透析对尿毒症患者的效果比较 [J]. 重庆医学, 2019, 48(A1): 295-296.
18
柳永兵, 胡大军. 生血宁片在维持性血液透析肾性贫血治疗中减少微炎症风险的临床观察 [J]. 中国药房, 2016, 27(8): 1096-1098.
19
徐海平, 李秀丽, 孙立娜, 等. 左卡尼汀对维持性血液透析患者炎症因子、氧化应激指标及心脏功能的影响 [J]. 中国药房, 2017, 28(11): 1558-1561.
20
Nakanishi T, Kuragano T, Nanami M, et al. Misdistribution of iron and oxidative stress in chronic kidney disease [J]. Free Radic Biol Med, 2019, 133: 248-253.
21
易晔, 卢远航, 冀倩倩. 生血宁和蔗糖铁对血液透析患者贫血、氧化应激及微炎症影响的比较 [J]. 中国药房, 2016, 27(5): 660-662.
22
Suzuki S, Shino M, Fujikawa T, et al. Plasma cystine levels and cardiovascular and all-cause mortality in hemodialysis patients [J]. Ther Apher Dial, 2018, 22(5): 476-484.
23
Martinez BK, White CM. The emerging role of inflammation in cardiovascular disease [J]. Ann Pharmacother, 2018, 52(8): 801-809.
24
朱士彦, 甘平, 吴楚海, 等. 老年维持性血液透析患者心脏电生理变化与心血管疾病相关性 [J]. 中国老年学杂志, 2019, 39(3): 515-517.
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