Deng Xiaofeng, Dai Qing, Wan Li, Tang Ling, Shu Yue, Xiao Hengfen, Bi Yuanyuan, Yang Hongfen
Department of Nephrology, the Second People's Hospital of Guiyang, Guiyang 550081, Guizhou, China (Deng XF, Dai Q, Wan L, Tang L, Shu Y, Xiao HF, Bi YY); Department of Clinical Laboratory, the Second People's Hospital of Guiyang, Guiyang 550081, Guizhou, China (Yang HF). Corresponding author: Tang Ling, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017 Jul;29(7):636-639. doi: 10.3760/cma.j.issn.2095-4352.2017.07.013.
To discuss the effects of multimodal combination dialysis on Klotho protein, fibroblast growth factor-23 (FGF-23) and brain natriuretic peptide (BNP) in patients with maintenance hemodialysis (MHD).
A randomized controlled trial (RCT) was conducted. 120 patients who was diagnosed with chronic renal failure (CRF) uremia receiving MHD over 3 months admitted to Blood Purification Centre of Department of Nephrology of the Second People's Hospital of Guiyang from December 2015 to December 2016 were enrolled, who were randomly divided into hemodialysis (HD) group (HD for 8 times a month), HD + hemofiltration (HF) group (HD for 8 times a month + HF once a month), and HD + HF + hemoperfusion (HP) group (HD for 8 times a month + HF for 4 times a month + HP once a month), with 40 patients in each group. Before and after treatment for 6 months and 12 months, blood was taken from venous circuit tube, the serum Klotho protein and FGF-23 levels were determined by enzyme linked immunosorbent assay (ELISA), and the serum BNP level was determined by electrochemiluminescence.
120 patients with MHD were enrolled in the final analysis without withdrawal. There were no significant differences in the levels of Klotho protein, FGF-23, or BNP before enrollment among the three groups (all P > 0.05). Compared with those before enrollment, the levels of serum Klotho protein after enrollment in three groups showed a sustained upward tendency, which were higher in HD + HF + HP group than in HD + HF group and HD group (μg/L: 2.59±0.61, 1.63±0.35, 1.13±0.26 at 6 months, F = 119.374, P = 0.000; 6.98±1.21, 3.57±1.03, 2.12±0.43 at 12 months, F = 275.675, P = 0.000); the levels of FGF-23 showed a sustained downward tendency, which were lower in HD + HF + HP group than in HD + HF group and HD group (ng/L: 69.22±38.26, 132.28±61.18, 178.50±74.64 at 6 months, F = 33.509, P = 0.000; 32.81±17.32, 87.93±43.27, 146.33±69.28 at 12 months, F = 55.466, P = 0.000); the BNP showed a similar tendency as FGF-23 (ng/L: 4 083.39±2 864.53, 7 245.69±4 643.81, 7 969.12±5 360.85 at 6 months, F = 8.758, P = 0.000; 1 521.86±894.63, 4 554.32±1 969.84, 5 013.89±2 033.64 at 12 months, F = 49.003, P = 0.000).
Multimodal combination dialysis can increase the Klotho protein level, and decrease the levels of FGF-23 and BNP in MHD patients with CRF uremia.
探讨多模式联合透析对维持性血液透析（MHD）患者 Klotho 蛋白、成纤维细胞生长因子 23（FGF - 23）和脑钠肽（BNP）的影响。
进行一项随机对照试验（RCT）。选取 2015 年 12 月至 2016 年 12 月在贵阳市第二人民医院肾内科血液净化中心收治的 120 例确诊为慢性肾衰竭（CRF）尿毒症且接受 MHD 超过 3 个月的患者，将其随机分为血液透析（HD）组（每月 HD 8 次）、HD + 血液滤过（HF）组（每月 HD 8 次 + HF 1 次）和 HD + HF + 血液灌流（HP）组（每月 HD 8 次 + HF 4 次 + HP 1 次），每组 40 例。在治疗 6 个月和 12 个月前后，从静脉回路管采集血液，采用酶联免疫吸附测定（ELISA）法测定血清 Klotho 蛋白和 FGF - 23 水平，采用电化学发光法测定血清 BNP水平。
120 例 MHD 患者纳入最终分析，无脱落病例。三组入组前 Klotho 蛋白、FGF - 23 或 BNP 水平比较，差异均无统计学意义（均P > 0.05）。与入组前比较，三组入组后血清 Klotho 蛋白水平均呈持续上升趋势，HD + HF + HP 组高于 HD + HF 组和 HD 组（6 个月时：μg/L：2.59±0.61，1.63±0.35，1.13±0.26，F = 119.374，P = 0.000；12 个月时：6.98±1.21，3.57±1.03，2.12±0.43，F = 275.675，P = 0.000）；FGF - 23 水平呈持续下降趋势，HD + HF + HP 组低于 HD + HF 组和 HD 组（6 个月时：ng/L：69.22±38.26，132.28±61.18，178.50±74.64，F = 33.509，P = 0.000；12 个月时：32.81±17.32，87.93±43.27，146.33±69.28，F = 55.466，P = 0.000）；BNP 与 FGF - 23 呈相似趋势（6 个月时：ng/L：4 083.39±2 864.53，7 245.69±4 643.81，7 969.12±5 360.
