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不同的血液净化方式对维持性血液透析患者微炎症状态的影响
引用本文:朱征西,陆绍强,梁碧琴,陆峰灵,农聪,黄辉.不同的血液净化方式对维持性血液透析患者微炎症状态的影响[J].中国血液净化,2011,10(1):18-21,28.
作者姓名:朱征西  陆绍强  梁碧琴  陆峰灵  农聪  黄辉
作者单位:广西百色市人民医院肾内科,广西百色,533000
摘    要:目的 观察常规血液透析(hemodialysis,HD)、高通量血液透析(high-flux hemodialysiS,HFD)、血液灌流(hemoperfusion,HP)对终末期肾病(end-stage renal disease,ESRD)维持性血液透析(maintenance hemodialysis,MHD)患者微炎症状态的影响.方法 选择广两百色市人民医院透析龄超过6个月的稳定MHD患者48例,随机分为HD组16例、HFD组16例和HD+HP组16例.3组患者分别在首次治疗前后,以及治疗3个月后透析前,通过免疫比浊法和酶联免疫吸附法(ELISA)测定患者C反应蛋白(C-reactive protein,CRP)、白细胞介素6(interteukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)血清含量,同时测定20例健康志愿者CRP、IL-6、TNF-α血清含量作为正常对照组.结果 3组MHD患者共48例治疗前的CRP、IL-6、TNF-α水平均高于正常对照组(P<0.001),各组间差异无统计学意义(P>0.05).HD组首次治疗后及治疗3个月后CRP、IL-6、TNF-α均升高,分别与治疗前比较差异均无统计学意义(P>0.05).HFD组首次治疗后CRP、IL-6、TNF-α均下降,与治疗前比较差异无统计学意义(P>0.05);治疗3个月后CRP下降,与治疗前比较差异无统计学意义(P>0.05),IL-6、TNF-α下降,与治疗前比较差异有统计学意义(P<0.05).HD+HP组首次治疗后CRP、IL-6、TNF-α均下降,其中CRP与治疗前比较差异无统计学意义(P>0.05),IL-6、TNF-α与治疗前比较差异有统计学意义(P<0.05);治疗3个月后,CRP、IL-6、TNF-α下降,与治疗前比较差异有统计学意义(P<0.05),但仍高于正常对照组.治疗3个月后,HD+HP组的CRP、IL-6、TNF-α值低于HFD组,差异有统计学意义(P<0.05),HD+HP组下降百分比高于HFD组,差异有统计学意义(P<0.01).结论 MHD患者存在微炎症状态.HFD和HP可以降低CRP、IL-6、TNF-α水平,改善患者的微炎症状态,HP可能优于HFD.3个月治疗并不能完全纠正微炎症状态,需进一步观察更长时间或联合其他治疗方法.

关 键 词:维持性血液透析  微炎症状态  高通量血液透析  血液灌流

The influence of various blood purification methods on microinflammatory state in patients with maintenance hemodialysis
ZHU Zheng-xi,LU Shao-qiang,LIANG Bi-qin,LU Feng-ling,NONG Cong,HUANG Hui.The influence of various blood purification methods on microinflammatory state in patients with maintenance hemodialysis[J].Chinese Journal of Blood Purification,2011,10(1):18-21,28.
Authors:ZHU Zheng-xi  LU Shao-qiang  LIANG Bi-qin  LU Feng-ling  NONG Cong  HUANG Hui
Institution:.Department of Nephrology,People's Hospital of Bai Se,Baise 533000,China
Abstract:Objective To investigate the influence of regular hemodialysis(HD),high-flux hemodialysis(HFD) and hemoperfusion(HP) on microinflammatory state in ESRD patients on maintenance hemodialysis(MHD).Methods We enrolled 48 patients with MHD for more than 6 months in this hospital and divided them randomly into HD group(n=16),HFD group(n=16) and HD+HP group(n=16).Serum CRP,IL-6 and TNF-α were measured by immunoturbidimetry and ELISA in patients before and after the first dialysis session,and after the treatment for 3 months,as well as in 20 healthy volunteers as normal controls.Results(a) Serum CRP,IL-6 and TNF-α were significantly higher in the 3 groups of patients than in normal controls(P0.001),but had no differences among the 3 groups of patients before the treatment(P 0.05).(b) In HD group,serum CRP,IL-6 and TNF-α increased after first dialysis session and after the treatment for 3 months,but the increases were statistically insignificantly(P0.05).(c) In HFD group serum CRP,IL-6 and TNF-α decreased after the first dialysis session,but the decreases were statistically insignificant(P 0.05).After the treatment for 3 months,however,serum IL-6 and TNF-α levels decreased significantly(P0.05) without change of serum CRP level(P0.05).(d) In HD+HP group,serum IL-6 and TNF-α decreased after the first dialysis session(P0.05) without change of serum CRP(P 0.05).After the treatment for 3 months,serum CRP,IL-6 and TNF-α decreased(P0.01),but were still higher than those of normal control group.(e) After the treatment for 3 months,serum CRP,IL-6 and TNF-α were significantly lower in HD+HP group than in HFD group,and the extent of the decreases was larger in HD+HP group than in HFD group.Conclusions(a) Microinflammation state exists in ESRD patients on MHD.(b) The lowering of patients' serum CRP,IL-6 and TNF-α and thus the recovery from microinflammatory state can be achieved by HFD and HP,and preferably by HP.(c) Patients' microinflammatory state can not radically corrected after 3 months treatment,therefore,other measures and longer period of follow-up must be conducted for these patients.
Keywords:Maintenance hemodialysis  Microinflammation state  High-flux hemodialysis  Hemoperfusion improvement
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