【摘要】目的：探究血液透析患者C反应蛋白、白蛋白、铁蛋白联合检测对营养不良-炎症综合征的评估价值。方法：回顾性选取2025年2月至2026年2月我院收治的血液透析患者104例作为研究对象，根据是否发生营养不良-炎症综合征（MICS）分为MICS组51例和单纯透析组53例，获取患者临床资料，并于透析前检测血清C反应蛋白、白蛋白、铁蛋白水平，采用多因素logistic回归分析影响血液透析患者发生MICS的危险因素，并采用ROC曲线评估各指标联合检测对MICS的诊断价值。结果：MICS组血清C反应蛋白、铁蛋白水平高于单纯透析组，血清白蛋白水平低于单纯透析组（P<0.05）。logistic回归分析结果显示，C反应蛋白、白蛋白、铁蛋白水平是影响血液透析患者发生MICS的危险因素（P<0.05）。ROC曲线分析结果显示，当白蛋白的最佳诊断截断值为（33.89）g/L，C反应蛋白的最佳诊断截断值为（13.17）mg/L，铁蛋白的最佳诊断截断值为（247.53）ng/mL，此时联合检测诊断MICS的AUC为0.973、敏感度为（98.00）和特异度为（83.02），高于任一单项指标检测（P<0.05）。结论：血液透析患者血清C反应蛋白、铁蛋白升高，血清白蛋白水平下降，三者联合诊断MIAS的临床价值较高。

目的：分析尿毒症维持性血液透析（MHD）患者红细胞相关指标、铁代谢指标水平及其同肾性贫血的关系。方法：选取我院2024年10月-2025年10月期间尿毒症MHD患者70例为研究对象，依照其是否发生肾性贫血分为贫血组（49例）、无贫血组（21例），对比两组患者红细胞相关指标以及等铁代谢指标，同时对比不同贫血严重程度患者各项指标水平差异，并分析尿毒症MHD患者肾性贫血的相关影响因素。结果：贫血组、无贫血组患者红细胞血红蛋白浓度（MCHC）、总铁结合力（TIBC）水平无较大差异（P＞0.05），贫血组患者网织红细胞计数（Ret）、血清铁蛋白（SF）、转铁蛋白（TRSF）水平低于无贫血组、平均红细胞体积（MCV）水平高于无贫血组（P＜0.05）；轻度组、中度组、重度组患者Ret、MCV、SF、TRSF差异显著（P＞0.05）；不同贫血严重程度患者MCHC、TIBC水平比较，差异无统计学意义（P＞0.05）；多因素Logistic回归结果显示，Ret（OR=0.2063）、MCV（OR=4.152）、SF（OR=0.341）、TRSF（OR=0.281）是尿毒症MHD患者发生肾性贫血的重要影响因素（P＜0.05）。结论：尿毒症MHD患者存在较高的肾性贫血风险，且不同贫血程度患者的Ret、MCV及SF、TRSF等指标水平存在差异性，亦是患者发生肾性贫血的重要影响因素。

Objective: To analyze the levels of red blood cell related indicators, iron metabolism indicators and their relationship with renal anemia in uremic patients with maintenance hemodialysis (MHD). Methods: 70 cases of uremic MHD patients in our hospital from October 2024 to October 2025 were selected as the research object, and were divided into anemia group (49 cases) and non anemia group (21 cases) according to whether renal anemia occurred. The red blood cell related indexes and iron metabolism indexes of the two groups were compared, and the differences of various indexes in patients with different anemia severity were compared, and the related influencing factors of renal anemia in uremic MHD patients were analyzed. Results: there was no significant difference in the levels of erythrocyte hemoglobin concentration (MCHC) and total iron binding capacity (TIBC) between anemia group and non anemia group (P>0.05). The levels of reticulocyte count (RET), serum ferritin (SF), transferrin (trsf) in anemia group we

目的：分析尿毒症维持性血液透析（MHD）患者红细胞相关指标、铁代谢指标水平及其同肾性贫血的关系。方法：选取我院2024年10月-2025年10月期间尿毒症MHD患者70例为研究对象，依照其是否发生肾性贫血分为贫血组（49例）、无贫血组（21例），对比两组患者红细胞相关指标以及等铁代谢指标，同时对比不同贫血严重程度患者各项指标水平差异，并分析尿毒症MHD患者肾性贫血的相关影响因素。结果：贫血组、无贫血组患者红细胞血红蛋白浓度（MCHC）、总铁结合力（TIBC）水平无较大差异（P＞0.05），贫血组患者网织红细胞计数（Ret）、血清铁蛋白（SF）、转铁蛋白（TRSF）水平低于无贫血组、平均红细胞体积（MCV）水平高于无贫血组（P＜0.05）；轻度组、中度组、重度组患者Ret、MCV、SF、TRSF差异显著（P＞0.05）；不同贫血严重程度患者MCHC、TIBC水平比较，差异无统计学意义（P＞0.05）；多因素Logistic回归结果显示，Ret（OR=0.2063）、MCV（OR=4.152）、SF（OR=0.341）、TRSF（OR=0.281）是尿毒症MHD患者发生肾性贫血的重要影响因素（P＜0.05）。结论：尿毒症MHD患者存在较高的肾性贫血风险，且不同贫血程度患者的Ret、MCV及SF、TRSF等指标水平存在差异性，亦是患者发生肾性贫血的重要影响因素。

To analyze the levels of red blood cell related indicators, iron metabolism indicators and their relationship with renal anemia in uremic patients with maintenance hemodialysis (MHD). Methods: 70 cases of uremic MHD patients in our hospital from October 2024 to October 2025 were selected as the research object, and were divided into anemia group (49 cases) and non anemia group (21 cases) according to whether renal anemia occurred. The red blood cell related indexes and iron metabolism indexes of the two groups were compared, and the differences of various indexes in patients with different anemia severity were compared, and the related influencing factors of renal anemia in uremic MHD patients were analyzed. Results: there was no significant difference in the levels of erythrocyte hemoglobin concentration (MCHC) and total iron binding capacity (TIBC) between anemia group and non anemia group (P>0.05). The levels of reticulocyte count (RET), serum ferritin (SF), transferrin (trsf) in anemia group were lower than those in non anemia group, and the level of mean corpuscular volume (MCV) was higher than that in non anemia group (P<0.05); There were significant differences in RET, MCV, SF and trsf among mild group, moderate group and severe group (P>0.05); There was no significant difference in MCHC and TIBC levels among patients with different anemia severity (P>0.05); Multivariate logistic regression results showed that RET (or=0.2063), MCV (or=4.152), SF (or=0.341), trsf (or=0.281) were important influencing factors of renal anemia in uremic MHD patients (P<0.05).Conclusion: Uremic MHD patients have a higher risk of renal anemia, and there are differences in the levels of Ret, MCV, SF, TRSF and other indicators among patients with different degrees of anemia, which are also important influencing factors for the occurrence of renal anemia in patients.

目的 探讨宣清导浊汤加减方联合血液透析治疗对老年慢性肾衰竭（CRF）患者肾功能、微炎症状态和毒素清除率的影响。方法 回顾性选取2019年10月—2022年10月我院收治的82例老年CRF患者,将其根据治疗方法分为联合组与单一组,每组41例。单一组仅采取血液透析治疗,联合组联合宣清导浊汤加减方治疗,对比两组患者治疗前后中医证候积分、毒素清除率、炎症因子变化。结果 治疗后,两组患者口淡不渴、肢体麻木、腰膝酸软、倦怠乏力、食少纳呆以及面色晦暗相关中医证候积分均降低,且联合组低于单一组（P<0.05）;治疗后两组患者血肌酐、尿素氮、血β₂-微球蛋白均降低,联合组低于单一组（P<0.05）;治疗后两组患者白细胞介素-6、C-反应蛋白、肿瘤坏死因子-α炎性因子水平明显降低,且联合组更低（P<0.05）。两组在治疗期间均无不良反应。结论 宣清导浊汤加减方联合血液透析治疗老年CRF患者效果较佳,可通过降低机体炎症因子表达水平、提高毒素清除率来改善患者临床症状,且不会增加不良反应。

Objective To explore the effect of Xuanqing Daozhuo Decoction modified formula combined with hemodialysis treatment on renal function,micro inflammatory status,and toxin clearance rate in elderly patients with chronic renal failure（CRF）．Methods Retrospectively,82 elderly CRF patients admitted to our hospital from October 2019 to October 2022 were selected and divided into a combination group and a single group according to the treatment methods,with 41 cases in each group． The single group was treated with hemodialysis only,and the combined group was treated with Xuanqing Daozhuo Decoction modified formula additionally．The changes of TCM syndrome scores,toxin clearance rate and inflammatory factors before and after treatment were compared between the two groups．Results After treatment,the scores of TCM syndroms including tasteless mouth and no thirst,numbness of limbs,soreness and weakness of waist and knee,fatigue,poor appetite and sluggish stomach were all decreased in 2 groups,and those in combined group were lower（P<0.05）．After treatment,serum creatinine,blood urea nitrogen and β₂-microglobulin were decreased in 2 groups,and those in combined group were lower（P<0.05）．After treatment,the levels of interleukin-6,C-reactive protein and tumor necrosis factor-α inflammatory factors were significantly decreased in 2 groups,which were lower in combination group（P<0.05）．The two groups had no adverse effects during the treatment period．Conclusions Xuanqing Daozhuo Decoction modified formula and hemodialysis can improve the clinical symptoms of elderly patients with CRF,reduce the expression level of inflammatory factors in patients,and increase the clearance rate of toxins in patients,and does not increase the adverse effects．

目的 通过对原位换管与首次置管比较,验证采用原位换管方式的可行性。方法 选取儿童肾内科先后采用了首次置管与原位换管的病例20例。将原位换管作为原位换管组,首次置管作为首次置管组,比较两组操作成功有效率、导管留置天数、最大血流速/体质量[mL/（min·kg）]、操作并发症的差异。结果 两组均一次性穿刺成功,两组在管道留置天数和血流速/体质量[mL/（min·kg）]及并发症比较差异均无统计学意义（P>0.05）。结论 原位换管与首次置管的效果相同,原位换管操作简单、对患者的损伤更小。

目的 探究维持性血液透析（MHD）患者的病耻感现状,并对其影响因素进行分析。方法 根据便利抽样法,选取2020年2月—2022月10月在河南省郑州市第三人民医院血液净化中心进行MHD治疗的236例患者作为研究对象,并采用一般资料调查问卷、领悟社会支持量表（PSSS）以及社会影响量表（SIS）进行调查。根据SIS得分情况进行分组,采用Logistic回归分析行MHD患者病耻感的影响因素。结果 MHD患者病耻感得分为（65.03±10.68）分,其中病程较短、社会支持度低、家庭平均收入低、文化水平较低以及未参加肾友会的患者病耻感得分较高,病程较长、家庭平均收入高、社会支持度高、参加肾友会以及文化水平较高者病耻感得分较低（P<0.05）。多因素Logistic回归分析结果显示,患者文化水平、家庭平均收入、是否参加肾友会、病程以及社会支持情况是患者病耻感的影响因素（P<0.05）。结论 MHD患者病耻感得分处于中高等水平。指导患者正确认识疾病,多关注家庭收入较低患者,鼓励患者积极参与肾友会,为患者提供良好的社会支持,均有助于降低其病耻感程度。

Objective To explore the current status of shame in maintenance hemodialysis（MHD）patients and analyze its influencing factors．Methods Based on the convenience sampling method,236 patients who underwent MHD treatment at the Blood Purification Center of the Third People’s Hospital of Zhengzhou City,Henan Province from February 2020 to October 2022 were selected as the research subjects．A general information survey questionnaire,Perceived Social Support Scale（PSSS）,and Social Impact Scale（SIS）were used for the survey．Grouping based on SIS scores,logistic regression analysis was used to analyze the influencing factors of shame in MHD patients．Results MHD patients had a shame score of（65.03±10.68）,among which patients with shorter disease course,lower social support,lower average family income,lower education level,and those who did not participate in kidney friend associations had higher shame scores．Patients with longer disease course,higher average family income,higher social support,participation in kidney self-help group,and higher education level had lower shame scores（P<0.05）．The results of multivariate logistic regression analysis showed that the patient’s educational level,average family income,participation in a kidney self-help group,course of illness,and social support were the influencing factors for the patient’s sense of shame（P<0.05）．Conclusions The shame score of MHD patients is at a moderate high level．Guiding patients to have a correct understanding of the disease,paying more attention to patients with lower family income,encouraging them to actively participate in kidney self-help group,and providing good social support to patients can all help reduce their sense of shame．

目的 探讨终末期肾病患者血液透析中实施基于依从性曲线变化规律的阶段性护理的效果。方法 选择2022年1月—2023年10月濮阳市人民医院收治的接受血液透析治疗的86例终末期肾病患者,将其通过单双号抽签的方式分组,即对照组与观察组,各43例,前者实施常规护理,后者在此基础上实施基于依从性曲线变化规律的阶段性护理,对比两组患者护理前后心理状态评分情况、生活质量评分情况及治疗依从性。结果 两组患者护理前后正性负性情绪量表（PANAS评分有一定差距,其中负性情绪显著降低,正性情绪显著提升,而护理后观察组负性情绪评分为（11.67±2.55）分,低于对照组的（16.11±3.02）分,正性情绪为（25.07±5.28）,高于对照组的（20.11±5.23）分（t=7.366、4.376,P<0.05）;护理后观察组生活质量综合评定量表（GQOLI-74）躯体、心理、社会及物质生活等维度评分分别为（82.17±7.11）分、（82.02±7.45）分、（81.11±7.78）分及（81.11±7.42）分,高于对照组的（71.22±7.23）分、（72.12±7.56）分、（71.23±7.45）分及（70.23±7.33）分（t=7.081、6.116、6.015、6.840,P<0.05）;观察组（95.35%）与对照组（76.74%）的治疗依从性比较,前者更高（χ²=6.198,P<0.05）。结论 基于依从性曲线变化规律的阶段性护理对于接受血液透析治疗的终末期肾病患者,不仅有助于调整其心理状态,还有助于提高其治疗依从性,使其生活质量也得以全面提高。

Objective To explore the effect of implementing phased nursing based on compliance curve changes in hemodialysis for end-stage renal disease patients. Methods The research deadline was from January,2022 to October,2023．The research object was 86 patients with end-stage renal disease who received hemodialysis treatment in Puyang People's Hospital,and they were divided into control group and observation group with 43 patients in each group by odd and even numbers．The former was given routine care,while the latter was given stage nursing based on the change of compliance curve．The psychological state score,quality of life score and treatment compliance of the two groups were compared before and after care. Results There was a certain difference in the Positive and Negative Affect Scale（PANAS）scores between the two groups before and after nursing,in which the negative emotion was significantly reduced and the positive emotion was significantly improved．After nursing,the negative emotion score of the observation group was（11.67±2.55）,which was significantly lower than that of the control group（16.11±3.02）,and the positive emotion score was（25.07±5.28）,which was significantly higher than that of the control group（20.11±5.23）（t=7.366,4.376,P<0.05）．After nursing,the scores of Generic Quality of Life Inventory-74（GQOLI-74）in the observation group were（82.17±7.11）,（82.02±7.45）,（81.11±7.78）and（81.11±7.42）,which were significantly higher than those in the control group（71.22±7.23）,（72.12±7.56）,（71.23±7.45）and（70.23±7.33）（t=7.081,6.116,6.015,6.840,P<0.05）．The treatment compliance of the observation group（95.35%）was higher than that of the control group（76.74%）（χ²=6.198,P<0.05）. Conclusions Choosing stage nursing based on the variation pattern of compliance curve for end-stage renal disease patients undergoing hemodialysis not only helps to adjust their psychological state,but also improves their treatment compliance,leading to a comprehensive improvement in their quality of life．

目的 了解维持性血液析透析（MHD）合并糖尿病患者与非合并糖尿病患者人体成分的差异,对MHD合并糖尿病患者透前体液分布特点进行分析。方法 选择MHD患者66例,按是否合并糖尿病分为MHD合并糖尿病组27例和MHD非合并糖尿病组39例,收集患者的临床资料、生化指标,应用生物电阻抗法测量患者细胞外液等人体成分参数,并进行比较。结果 MHD合并糖尿病组患者细胞外液、细胞外液/总体水量、脂肪组织指数、收缩压、超滤量、血糖高于MHD非糖尿病组,差异有统计学意义;MHD合并糖尿病组患者血红蛋白低于MHD非糖尿病组,差异有统计学意义。结论 相比较MHD非糖尿病患者,MHD合并糖尿病的患者透前细胞外液、细胞外液/总体水量、脂肪含量分布异常情况更明显,高血压及贫血情况更严重。MHD合并糖尿病患者容量控制较非糖尿病组差,故需对糖尿病患者加强宣传教育,严格控制血糖水平和液体的摄入。

目的 观察帕立骨化醇治疗维持性血液透析并发继发性甲状旁腺功能亢进（SHPT）患者6个月的疗效。方法 选取40例血液透析合并 SHPT的患者,分成观察组和对照组,分别使用帕立骨化醇和骨化三醇治疗6个月,监测治疗前、治疗后血清全段甲状旁腺素（iPTH）、血钙、血磷水平。比较2组患者治疗6个月后iPTH、血钙、血磷变化情况。结果 治疗6个月后,观察组iPTH水平较对照组下降,观察组血钙水平较对照组上升幅度小,观察组血磷水平较对照组下降。结论 帕立骨化醇治疗6个月能显著降低血透并发SHPT患者的iPTH水平,治疗效果显著,且不会增加高钙、高磷血症风险,药物安全性好。

Objective To observe the effectiveness of paricalcitol in the 6-month treatment of maintenance hemodialysis patients with secondary hyperparathyroidism（SHPT）．Methods Forty maintenance hemodialysis patients with SHPT were selected and divided into observation group and control group．They were treated with paricalcitol or calcitriol for 6 months,respectively．Serum levels of intact parathyroid hormone（iPTH）,calcium and phosphorus were monitored before and after treatment．The changes of iPTH,calcium and phosphorus were compared between the two groups after 6 months of treatment．Results After 6 months of treatment,the level of iPTH in the observation group decreased significantly compared with the control group,the level of calcium in the observation group increased slightly compared with the control group,and the level of phosphorus in the observation group decreased significantly compared with the control group．Conclusions This observational study shows that paricalcitol can significantly reduce the iPTH level in hemodialysis patients with SHPT after treatment for 6 months,without increasing the risk of hypercalcemia and hyperphosphatemia.

目的 探讨进食时机对尿毒症血液透析患者的影响,为临床上此类研究提供参考依据。方法 选取2018年5月—2020年5月于我院进行血液透析的患者42例,根据自身随机对照法分为A组（n=21）和B组（n=21）。A组患者前六次在血液透析1.5 h时进食,后六次在血液透析2.5 h时进食;B组患者前六次在血液透析2.5 h时进食,后六次在血液透析1.5 h时进食。观察比较1.5 h和2.5 h进食的患者在血液透析前以及血液透析中不同时间点的血压和血糖。结果 2组患者在不同时间点的血压值和低血压发生率比较差异无统计学意义（P>0.05）;血液透析1.5 h进食患者在透析2 h和3 h时血糖值明显高于2.5 h进食患者,比较差异具有统计学意义（P<0.05）;血液透析1.5 h进食的患者在透析2 h时低血糖的发生率显著低于2.5 h进食患者,差异具有统计学意义（P<0.05）。结论 对尿毒症血液透析患者来说,于血液透析1.5 h进食能够有效降低患者低血压和低血糖的发生几率。

Objective To discuss the influence of eating timing on uremic hemodialysis patients,and to provide a reference for this kind of clinical research．Methods A total of 42 patients undergoing hemodialysis were selected in our hospital from May 2018 to May 2020 and were divided into group A（n=21）and group B（n=21）according to self randomized control method．Patients in group A ate at 1.5 hour of hemodialysis for the first six times,and at 2.5 hour of hemodialysis for the last six times;patients in group B ate at 2.5 hour of hemodialysis for the first six times,and at 1.5 hour of hemodialysis for the last six times．Observed and compared the blood pressure and blood sugar of patients who eat at 1.5 hour and 2.5 hour before hemodialysis and at different time points during hemodialysis．Results There were no significant differences in blood pressure and the incidence of hypotension between the two groups of patients at different time points（P>0.05）;the blood glucose levels at 2 and 3 hour of the patients who ate at 1.5 hour of hemodialysis was significantly higher than that of the patients who ate at 2.5 hour,and the difference was statistically significant（P<0.05）;the incidence of hypoglycemia at 2 hour of hemodialysis in patients who ate at 1.5 hour was significantly lower than that of patients who ate at 2.5 hour,and the difference was statistically significant（P<0.05）．Conclusions For uremic hemodialysis patients,eating at 1.5 hour of hemodialysis could effectively reduce the incidence of hypotension and hypoglycemia．