目的 探讨复方α-酮酸联合血液灌流治疗维持性血液透析患者营养不良-炎症反应综合征的临床疗效。方法 选择2013年5月—2014年9月上海市第十人民医院收治的维持性血液透析营养不良-炎症反应综合征患者80例,随机分为治疗组与对照组,每组各40例。对照组给予血液灌流治疗,治疗时间为2 h,2次/周。治疗组在对照组治疗的基础上口服复方α-酮酸片,4片/次,3次/d。两组均连续治疗3个月。比较治疗前后两组营养不良-炎症反应评分(MIS)评分、主管综合营养评分(SGA)、体质量指数(BMI)、血清白蛋白(Alb)、转铁蛋白(TRF)、血红蛋白(Hb)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、成纤维细胞生长因子-23(FGF-23)、血浆瘦素、血清1,25-(OH)₂D₃水平的变化。比较两组治疗前后肱三头肌皮褶厚度(TSF)、上臂围(MAC),上臂肌围(MAMC)的变化。结果 治疗后,两组MIS评分、CRP、TNF-α、瘦素、FGF-23显著降低,SGA评分、BMI、TSF、MAC、Alb、TRF、Hb、1,25-(OH)₂D₃均显著升高,同组治疗前后差异有统计学意义(P< 0.05);且治疗组这些观察指标的改善程度优于对照组,两组比较差异有统计学意义(P< 0.05)。结论 复方α-酮酸片联合血液灌流治疗维持性血液透析患者营养不良-炎症反应综合征具有较好的临床疗效,可有效改善患者的营养状况,缓解患者微炎症状态,具有一定的临床推广应用价值。

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.