目的 探討復(fù)方α-酮酸聯(lián)合血液灌流治療維持性血液透析患者營(yíng)養(yǎng)不良-炎癥反應(yīng)綜合征的臨床療效。方法 選擇2013年5月—2014年9月上海市第十人民醫(yī)院收治的維持性血液透析營(yíng)養(yǎng)不良-炎癥反應(yīng)綜合征患者80例,隨機(jī)分為治療組與對(duì)照組,每組各40例。對(duì)照組給予血液灌流治療,治療時(shí)間為2 h,2次/周。治療組在對(duì)照組治療的基礎(chǔ)上口服復(fù)方α-酮酸片,4片/次,3次/d。兩組均連續(xù)治療3個(gè)月。比較治療前后兩組營(yíng)養(yǎng)不良-炎癥反應(yīng)評(píng)分(MIS)評(píng)分、主管綜合營(yíng)養(yǎng)評(píng)分(SGA)、體質(zhì)量指數(shù)(BMI)、血清白蛋白(Alb)、轉(zhuǎn)鐵蛋白(TRF)、血紅蛋白(Hb)、C反應(yīng)蛋白(CRP)、腫瘤壞死因子α(TNF-α)、成纖維細(xì)胞生長(zhǎng)因子-23(FGF-23)、血漿瘦素、血清1,25-(OH)₂D₃水平的變化。比較兩組治療前后肱三頭肌皮褶厚度(TSF)、上臂圍(MAC),上臂肌圍(MAMC)的變化。結(jié)果 治療后,兩組MIS評(píng)分、CRP、TNF-α、瘦素、FGF-23顯著降低,SGA評(píng)分、BMI、TSF、MAC、Alb、TRF、Hb、1,25-(OH)₂D₃均顯著升高,同組治療前后差異有統(tǒng)計(jì)學(xué)意義(P< 0.05);且治療組這些觀察指標(biāo)的改善程度優(yōu)于對(duì)照組,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P< 0.05)。結(jié)論 復(fù)方α-酮酸片聯(lián)合血液灌流治療維持性血液透析患者營(yíng)養(yǎng)不良-炎癥反應(yīng)綜合征具有較好的臨床療效,可有效改善患者的營(yíng)養(yǎng)狀況,緩解患者微炎癥狀態(tài),具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To explore the clinical effect of compound α-ketoacid combined with hemoperfusion in treatment of maintenance hemodialysis patients with malnutrition-inflammatory response syndrome. Methods Patients (80 cases) with maintenance hemodialysis with malnutrition-inflammatory response syndrome in Shanghai Tenth People's Hospital from May 2013 to September 2014 were randomly divided into control and treatment groups, and each group had 40 cases. The patients in the control group were given hemoperfusion, 2 h/time, twice weekly. The patients in the treatment group were po administered with Compound α-Ketoacid Tablets during the meals on the basis of the control group, 4 tablets/time, three times daily. The patients in two groups were treated for 3 months. After treatment, MIS scores, SGA scores, BMI, Alb, TRF, Hb, CRP, TNF-α, FGF-23, leptin, and 1,25-(OH)₂D₃ in two groups before and after treatment were compared. At the same time, TSF, MAC, and MAMC in two groups were also compared. Results After treatment, MIS scores, CRP, TNF-α, leptin, and FGF-23 in two groups were significantly decreased, and SGA scores, BMI, TSF, MAC, Alb, TRF, Hb, and 1,25-(OH)₂D₃ were significantly increased, and the difference was statistically significant in the same group (P < 0.05). These observational indexes in treatment group were better than those in control group, with significant difference between two groups (P < 0.05). Conclusion Compound α-Ketoacid Tablets combined with hemoperfusion has clinical curative effect in treatment of maintenance hemodialysis patients with malnutrition-inflammatory response syndrome, and can effectively improve the nutritional status of patients, and can ease inflammatory states, which has a certain clinical application value.