Li Wendong, Wang Jing, Wang Yanqin, Guan Rui, Zhao Fan, Zhang Rongrong
Department of Nephrology, Baoji People's Hospital Baoji 721000, Shaanxi, China.
Traditional Chinese Medicine Department, Baoji Maternal and Child Health Hospital Baoji 721000, Shaanxi, China.
Am J Transl Res. 2023 Jun 15;15(6):4045-4054. eCollection 2023.
To determine the efficacy of hemodialysis combined with hemoperfusion with acupuncture on calcium-phosphorus metabolism disorder (CPMD) of patients who had received maintenance hemodialysis and its effect on intact parathyroid hormone (iPTH) and nutritional status.
Data from 142 patients who were treated and given maintenance hemodialysis in Baoji People's Hospital from March 2018 to February 2020 were analyzed retrospectively. Patients treated with hemodialysis and acupuncture-moxibustion adjuvant therapy were enrolled into the control group (n=58), while those treated with hemoperfusion in addition to hemodialysis and acupuncture-moxibustion adjuvant therapy were enrolled into the research group (n=84). The two groups were compared in terms of changes in iPTH, calcium-phosphorus product, serum calcium (Ca), serum phosphorus (P), β2 microglobulin (β2-MG), serum albumin (Alb), creatinine (Scr) and urea nitrogen (BUN). The clinical efficacy in the two groups was compared after therapy, and the two groups were also compared in the improvement of immune function-related indexes (IgG and IgM) and the changes of nutrition-related indexes (Alb, prealbumin (PA) and hemoglobin (Hb)) before and after treatment. A risk prediction model was constructed based on LASSO regression to evaluate the predictive value of the risk score for efficacy of patients.
After treatment, the research group presented significantly lower levels of P, iPTH, and calcium-phosphorus product than the control group, but a significantly higher Ca level than the control group (all P<0.05). In addition, after treatment, the research group showed significantly lower levels of β2-MG, Scr and BUN but a higher Alb level than the control group (all P<0.05). After treatment, the research group had a greater improvement in immune function-related indexes (IgG and IgM) than the control group (all P<0.05), while the control group had significantly decreased Alb, PA and Hb after treatment (all P<0.05), but the levels of these in the research group did not change greatly (all P>0.05). Risk scoring formula was constructed: risk score = (dialysis time * 0.057123881) + (Ca * -0.100413548) + (P * 0.100419363) + (calcium and phosphorus product * 0.03872268) + (iPTH * 0.000358779). According to inter-group comparison of risk score, the Improvement group got a lower risk score than the Non-improvement group (P<0.0001). Moreover, according to ROC curve-based analysis, the area under the curve of risk score in predicting the efficacy of patients was 0.991.
Hemodialysis combined with acupuncture and blood perfusion can control the immune regulation by increasing the blood calcium content without affecting nutritional status, but it has no significant effect on the efficacy in patients.
探讨血液透析联合血液灌流及针刺治疗对维持性血液透析患者钙磷代谢紊乱（CPMD）的疗效及其对全段甲状旁腺激素（iPTH）和营养状况的影响。
回顾性分析2018年3月至2020年2月在宝鸡市人民医院接受维持性血液透析治疗的142例患者的资料。采用血液透析及针灸辅助治疗的患者纳入对照组（n = 58），采用血液灌流联合血液透析及针灸辅助治疗的患者纳入研究组（n = 84）。比较两组患者iPTH、钙磷乘积、血清钙（Ca）、血清磷（P）、β2微球蛋白（β2-MG）、血清白蛋白（Alb）、肌酐（Scr）和尿素氮（BUN）的变化。比较两组治疗后的临床疗效，以及两组治疗前后免疫功能相关指标（IgG和IgM）的改善情况和营养相关指标（Alb、前白蛋白（PA）和血红蛋白（Hb））的变化。基于LASSO回归构建风险预测模型，评估风险评分对患者疗效的预测价值。
治疗后，研究组患者的P、iPTH及钙磷乘积水平显著低于对照组，但Ca水平显著高于对照组（均P < 0.05）。此外，治疗后，研究组患者的β2-MG、Scr和BUN水平显著低于对照组，但Alb水平高于对照组（均P < 0.05）。治疗后，研究组免疫功能相关指标（IgG和IgM）的改善程度大于对照组（均P < 0.05），而对照组治疗后Alb、PA和Hb水平显著下降（均P < 0.05），但研究组这些指标变化不大（均P > 0.05）。构建风险评分公式：风险评分 =（透析时间 * 0.057123881）+（Ca * -0.100413548）+（P * 0.100419363）+（钙磷乘积 * 0.03872268）+（iPTH * 0.000358779）。根据风险评分的组间比较，改善组的风险评分低于未改善组（P < 0.0001）。此外，根据基于ROC曲线的分析，风险评分预测患者疗效的曲线下面积为0.991。
血液透析联合针刺及血液灌流可通过提高血钙含量控制免疫调节，且不影响营养状况，但对患者疗效无显著影响。
