ABSTRACT
【Objective】 To compare the effects of low flux and high flux hemodialysis on insulin resistance (IR), inflammatory factors and coronary artery calcification(CAC) in patients with non-diabetic end-stage renal disease (ESRD), and analyze the related factors affecting the prognosis survival of patients. 【Methods】 A total of 217 patients with non-diabetic ESRD treated in our hospital from February 2015 to April 2017 were selected and randomly divided into control group (n=108) and observation group (n=109) according to the random number table. Low flux and high flux hemodialysis were adopted respectively. Baseline data, renal function, lipid metabolism, inflammatory factors, IR, CAC, complications, outcomes and health and economic benefits of the two groups were compared. The patients were followed up for 3 years and divided into survival group (n=130) and death group (n=75). The clinical data of the two groups were compared and related factors affecting the prognosis and survival were analyzed. 【Results】 Scr, BUN, UAER, TC, TG and LDL-C in the two groups were significantly lower than those before treatment [control group: Scr (μmol/L)349.62±37.16 vs 201.73±24.58, BUN (mmol/L) 28.43±5.39 vs20.81±3.47, UAER(μg /min)60.14±11.52 vs 55.73±9.86, TC (mmol/L)5.46±0.93 vs 4.75±0.69, TG (mmol/L)2.58±0.64 vs 2.13±0.57, LDL-C(mmol/L)3.69±0.73 vs 2.45±0.60; observation group: Scr (μmol/L) 352.14±38.29 vs 136.85±16.47, BUN (mmol/L) 27.96±5.25 vs17.56±3.68, UAER(μg /min) 60.32±12.07 vs 49.85±7.42, TC (mmol/L)5.48±0.97 vs 4.27±0.56, TG (mmol/L) 2.55±0.62 vs 1.49±0.35, LDL-C(mmol/L) 3.72±0.74 vs1.91±0.48), and eGFR and HDL-C were significantly higher than those before treatment [control group: eGFR(mL/min/1.73m)29.32±3.25 vs 72.54±7.86, HDL-C(mmol/L)1.13±0.24 vs1.28±0.31, observation group: eGFR(mL/min/1.73m)30.05±3.29 vs 121.63±13.34, HDL-C(mmol/L)1.09±0.22 vs 1.57±0.46), differences between groups were statistically significant (P<0.05); FBG, FINS, HOMA-IR, IL-6, IL-8, TNF-α and hs-CRP in the two groups were significantly lower than those before treatment [control group: FBG(mmol/L)4.99±0.95 vs 4.52±0.63, FINS(mU/L)12.93±2.54 vs10.15±2.21, HOMA-IR 2.87±0.54 vs 2.04±0.43, IL-6(pg/mL)120.16±13.54 vs 75.94±9.28, IL-8(mg/L)56.83±6.15 vs 41.52±5.38, TNF-α(ng/L)50.03±5.42 vs 45.62±4.81, hs-CRP(mg/L)26.75±2.79 vs 14.37±2.19; observation group: FBG(mmol/L)5.01±0.97 vs 4.11±0.56, FINS(mU/L)13.07±2.62 vs 8.86±1.79, HOMA-IR 2.91±0.55 vs 1.62±0.31, IL-6(pg/mL)119.85±12.91 vs 31.07±4.46, IL-8(mg/L)57.04±6.09 vs 32.65±4.27, TNF-α(ng/L)49.78±5.36 vs 40.15±4.27, hs-CRP(mg/L)23.04±2.82 vs 7.56±1.03], and the CACS score was significantly higher than that before treatment(control group: 26.75±2.79 vs 53.68±26.93, observation group: 27.04±2.82 vs 75.49±7.66), differences between groups are statistically significant (all P<0.05). Compared with the control group, the total incidence of complications during dialysis was significantly lower in the observation group (P<0.05), and has more economic advantages.Venerable age(OR=1.893, P<0.05), low HDL-C level(OR=0.575, P<0.05), high CACS score(OR=2.384, P<0.05), and high hs-CRP level(OR=3.526, P<0.05) were independent risk factors affecting the survival rate of non-diabetic ESRD patients after dialysis treatment (P<0.05). 【Conclusion】 Compared with low-flux hemodialysis, high-flux hemodialysis has significant effects in improving renal function, lipid metabolism, IR, micro-inflammatory state, and reducing CAC progression and complications, with more prominent cost-effectiveness advantages. HDL-C and Hs-CRP levels and CACS scores of patients should be closely monitored during clinical application, and active preventive measures should be taken to improve the survival rate of patients.
ABSTRACT
Objective To discuss the expressions of VEGF ,EGFR and Smad4 in breast cancer tissue and their relationship with lymphatic metastasis .Methods 84 patients with breast cancer from June 2014 to June 2016 in our hospital were selected ,immuno-histochemical method was used to detect the expressions of VEGF ,EGFR and Smad4 ,and their relationship with lymphatic metas-tasis was analyzed .Results The positive expression rates of VEGF and EGFR were 22 .62% and 26 .19% respectively in breast cancer tissue ,which were notably higher than those in para-carcinoma tissue(22 .62% and 26 .19% respectively) ,and differences were statistically significant (P<0 .05) .Positive expression rate of Smad4 was 35 .71% in breast cancer tissue ,which was higher than that in para-carcinoma tissue(77 .38% ) ,and the difference was statistically significant (P< 0 .05) .The positive expression rates of EGFR and VEGF were 72 .92% and 70 .83% in Ⅲ + Ⅳ phase ,which were higher than those in Ⅰ + Ⅱ phase(50 .00% and 44 .44% ,respectively) ,differences were statistically significant(P<0 .05) .The positive expression of Smad2 was 25 .00% in Ⅲ +Ⅳphase ,which was lower than that in control group (50 .00% ) ,and the difference was statistically significant (P<0 .05) .The pos-itive expression rates of EGFR and VEGF were 77 .27% and 75 .00% in patients with lymphatic metastasis ,which were higher than those in patients without lymphatic metastasis (47 .50% and 42 .50% ) ,and differences were statistically significant (P< 0 .05) . The positive expression of Smad4 was 22 .73% in patients with lymphatic metastasis ,which was lower than that in patients without lymphatic metastasis (50 .00% ) ,and the difference was statistically significant (P<0 .05) .Pearson analysis showed that the posi-tive expression rates of EGFR and VEGF were positively associated with lymphatic metastasis (r1 =0 .382 ,r2 =0 .425 ,P<0 .05) , and the positive expression rate of Smad2 was negatively associated with lymphatic metastasis (r3 = -0 .468 ,P<0 .05) .Conclusion VEGF ,EGFR and Smad4 play an important role in the occurrence and development of breast cancer .The positive expression rates of EGFR and VEGF were positively associated with lymphatic metastasis ,and the positive expression rate of Smad2 was negatively associated with lymphatic metastasis ,which could have a guiding significance for prognosis of breast cancer .