The efficacy of continuous blood purification in the treatment of severe heart failure combined with renal failure / 中国医师进修杂志

ABSTRACT

Objective:To explore the clinical value of continuous blood purification(CBP) in patients with severe heart failure combined with renal failure and its effect on serum p66Shc protein, soluble fms-like tyrosine kinase receptor 1 (sFlt-1), and tissue inhibitor of metalloproteinase-1 (TIMP-1).Methods:Ninety-seven patients with severe heart failure combined with renal failure admitted to the Chaoyang Central Hospital from March 2017 to October 2019 were enrolled and they were divided into the control group (48 cases) and the observation group (49 cases) according to the random number table method. The control group was treated with intermittent hemodialysis (IHD), while the observation group was treated with CBP. Changes of the efficacy, the renal function indexes, cardiac function indexes, p66Shc protein, sFlt-1, TIMP-1 before and after treatment were compared between the two groups. The occurrence of adverse reactions were recorded.Results:The total effective rate in the observation group was better than thatin the control group 79.59% (39/49) vs. 60.42% (29/48), χ 2 = 4.25, P<0.05. After treated for 1 week, the levels of blood urea nitrogen, serum creatinine, serum phosphorus, blood uric acid and β2 microglobulinin the observation group were lower than those in the control group (12.63 ± 3.14) mmol/L vs. (16.23 ± 4.74) mmol/L, (175.52 ± 39.57) μmol/L vs. (240.15 ± 50.18) μmol/L, (1.20 ± 0.23) mmol/L vs. (1.37 ± 0.31) mmol/L, (265.15 ± 34.79) μmol/L vs.(297.52 ± 50.07) μmol/L, (28.75 ± 5.14) mg/L vs. (33.52 ± 7.39) mg/L, the differences were statistically significant ( P<0.05). The levels of left ventricular ejection fraction, cardiac output and stroke volume in the observation group were higher than those in the control group (53.63 ± 7.96)% vs. (49.52 ± 5.14)%, (58.45 ± 15.23) ml vs. (49.58 ± 9.52) ml, (4.59 ± 0.52) L/min vs. (4.01 ± 0.23) L/min, the differences were statistically significant ( P<0.05). The levels of p66Shc, sFlt-1, TIMP-1 in the observation group were lower than thosein the control group 1.11 ± 0.36 vs. 1.45 ± 0.42, (15.76 ± 4.34) μg/L vs. (19.87 ± 5.66) μg/L, (59.14 ± 10.57) μg/L vs. (65.39 ± 9.45) μg/L, the differences were statistically significant ( P<0.05). The total adverse reaction rate in the observation group was lower than that in the observation group 14.29% (7/49) vs. 31.25% (15/48), χ2 = 3.98, P<0.05. Conclusions:CBP therapy for patients with severe heart failure combined with renal failure has better efficacy than IHD, and can improve the patient′s cardiac and kidney function, reduce the levels of p66Shc protein, sFlt-1 and TIMP-1, reduce adverse reactions. It is safe and feasible.