| Objective:To observe and understand the microinflammation indexes and their changes in maintenance hemodialysis patients before and after the treatments of high-flux hemodialysis combined with compoundɑ-Ketoacids and Bailing capsule and analyze the relationship between inflammation indexes and nutritional indexes.To study the influence of different treatments on microinflammation,which can provide a reference for alleviating the patients’microinflammation status and improving their living quality.Methods:Selecting 120 maintenance hemodialysis patients in the blood purification center of the Second Affiliated Hospital of Guilin Medical College from March 2015 to June 2019 as the object of study,according to different treatments,the patients were randomized into low-flux hemodialysis group(group A,30 cases),high-flux hemodialysis group(group B,30 cases),low-flux hemodialysis combined with compoundɑ-ketoacids and Bailing capsule treatment group(group C,30 cases),high-flux hemodialysis combined with compoundɑ-ketoacids and Bailing capsule treatment group(group D,30 cases).The material of low-flux dialyzers used in the study was polysulfone membrane,the brand was WEGO,and the specifications were F14 dialyzers(membrane area:1.4m~2),of which the filtration coefficient was18.0ml/(h.mm Hg).The material of high-flux dialyzers was polyethersulfone membrane,the brand was OCI Medical,and the specifications were OCI-HD150(membrane area:1.5m~2),of which the filtration coefficient was48.0ml/(h.mm Hg).High-flux dialyzers were applied to hemodialysis machine equipped with biofilter.Compoundɑ-Ketoacids were produced by WINUNNY,and taken 2.52g orally three times with meals.Bailing capsules were produced by Hua Dong medical,and taken 1000mg orally three times a day.Dialysis in four groups was performed three times a week for four hours each time.Patients with dialysis were all established with arteriovenous fistula.Carbonate dialysate was put to use.The blood flow volume was controlled at 200-250ml/min,and the dialysate flow rate was 500ml/min.Heparin was routinely used as anticoagulant,however,in the case of bleeding,heparin was not administered.We obtained the patient’s general information and hemodialysis-related data through medical records.Venous blood of the upper limbs were drawn when patients were fasting in the morning at baseline and 6 months after the blood purification treatment to measure C-reactive protein(CRP),ferritin(Fer)and interleukin-6(IL-6)levels.The serum total protein(TP),serum albumin(ALB),hemoglobin(Hb)and so on were detected by biochemical analyzer,and intact parathyroid hormone(i PTH)andβ2 microglobulin(β2-MG)were measured by enzyme-linked immunosorbent assay.The level of cysteine protease inhibitor(Cys C)was detected by radioimmunoassay.And the final results were analyzed by SPSS 20.0 statistical software.Results:1)From the perspective of the nutritional indicators of patients,after undergoing a 6-month treatment period,the subjective nutrition scores of the four groups of patients were(5.24±1.12)、(4.31±1.19)、(3.15±1.32)、(3.15±1.25),the total protein was(69.31±6.89)g/L、(70.95±5.38)g/L、(69.79±6.26)g/L、(71.64±5.87)g/L,the albumin is(39.42±3.59)g/L、(40.85±3.14)g/L、(40.54±3.71)g/L、(40.91±2.92)g/L,the prealbumin is509.83±113.28,(509.83±113.28)mg/L、(539.16±146.79)mg/L、(535.88±140.16)mg/L、(536.67±139.42)mg/L,and the hemoglobin were(92.49±12.94)g/L、(101.74±21.32)g/L、(101.75±14.97)g/L、(102.96±14.48)g/L.All P values are less than the critical value level of 0.05,indicating that there is a significant statistical difference between the groups.There are significant statistical differences between the D group and the other three groups in the pairwise comparison between the treatment groups.The subjective nutrition score of the D group after treatment was lower than that of the other three groups,and total protein,albumin,prealbumin,and hemoglobin were higher than those of the other three groups.2)From the point of view of the inflammation indicators of the patients,after 3 months of treatment,the C-reactive protein of the four groups of patients after the treatment was(25.32±18.47)mg/L、(8.95±9.73)mg/L、(11.61±8.39)mg/L、(7.46±10.54)mg/L,the Ferritin is(159.37±58.42)ug/L、(93.58±48.61)ug/L、(102.94±70.57)ug/L、(85.39±48.25)ug/L,and the interleukin-6i s(1 0 6.3 4±1 2.4 6)n g/L、(9 7.4 9±1 3.2 9)ng/L、(100.58±14.73)ng/L、(72.65±10.74)ng/L.The p-values are all less than 0.05,and there are obvious statistical differences.There are significant statistical differences between the D group and the other three groups in the pairwise comparison between the treatment groups.The content of C-reactive protein,ferritin,and interleukin-6 in the highfluxhemodialysis combined withcompoundɑ-ketoacid tablets and Bailing capsules treatment group was significantly lower than that of the other three groups.This shows that the D group has a better effect than the other three groups in reducing the level of microinflammation.3)From the perspective of adiponectin and lipid metabolism indicators,after 3 months of treatment,the adiponectin of the four groups of patients after treatment was(10.49±6.84)ug/ml,(20.36±26.38)ug/ml,(16.31±16.72)ug/ml and(26.97±26.49)ug/ml,the total cholesterol was(5.02±0.47)mmol/L,(4.38±0.45)mmol/L,(4.71±1.53)mmol/L,and(4.17±0.82)mmol/L,the triglycerides were(1.26±0.57)mmol/L,(1.37±0.44)mmol/L,(1.31±0.89)mmol/L,(1.34±0.82)mmol/L,the low-density lipoproteins were(1.79±0.84)mmol/L,(1.21±0.17)mmol/L,(1.82±1.39)mmol/L,(1.20±0.32)mmol/L,and the high-density lipoproteins are(2.39±0.61)mmol/L,(2.45±0.64)mmol/L,(2.40±0.73)mmol/L,(2.52±0.29)mmol/L.The p-values are all below the critical value level of 0.05,and there are significant statistical differences.There are significant statistical differences between the D group and the other three groups in the pairwise comparison between the treatment groups.The mean values of adiponectin and highfluxhemodialysis in the D group were significantly higher than those in the other three groups,and total cholesterol,triglycerides,and lowfluxhemodialysis were lower than those in the other three groups.Before and after treatment,the p value of the D group is also less than thecritical value of 0.05,which has obvious statistical significance.Conclusion:(1)Patients in the low-flux hemodialysis group had the highest microinflammation indicators.high-flux hemodialysis was more effective in removing inflammatory factors than low-flux hemodialysis combined with compoundɑ-ketoacids and Bailing capsules,while high-flux hemodialysis combined with compoundɑ-ketoacids and Bailing Capsules have the most significant effect on improving microinflammation indexes of maintenance hemodialysis patients.(2)The level of plasma adiponectin has a predictive effect on the microinflammation and malnutrition status of maintenance hemodialysis patients.(3)The treatment group of high-flux hemodialysis combined with compoundɑ-ketoacids and Bailing capsules had better effects on maintenance hemodialysis patients in toxin clearance,inflammation improvement,and malnutrition compared with the low-flux hemodialysis group,high-flux hemodialysis group,and treatment group of low fluxhemodialysiscombined with compoundɑ-ketoacids tabletsand Bailing capsules. |
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