血液灌流改善继发性甲旁亢患者微炎症状态的临床研究

目的比较血液透析联合血液灌流与常规血液透析、血液透析滤过对慢性肾功能衰竭继发性甲旁亢患者甲状旁腺激素(iPTH)和微炎症状态的影响。方法将60例维持性血液透析患者采用完全随机方法分为3组:血液透析组(HD)、血液透析滤过组(HDF)和血液透析+血液灌流组(HD+HP),比较对血清iPTH、白介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor Necrosis factor-α,TNF-α)和C-反应蛋白(c-reactive protein,CRP)的清除率以及对临床症状的改善。结果 (1)HD+HP组治疗前后血CRP水平比较有显著性差异(P<0.05),HD+HP组和HDF组治疗前后血iPTH、IL-6、TNF-α水平比较有显著性差异(P<0.05),HD组治疗前后比较均无显著性差异(P>0.05)。HD+HP组iPTH、IL-6、TNF-α清除率比HDF组高(P<0.05)。(2)HD+HP组、HDF组治疗后骨痛和肌无力、皮肤瘙痒、心绞痛等均明显好转,有效率均优于HD组(P<0.05);HD+HP组的治疗有效率优于HDF组(P<0.05)。(3)患者CRP与IL-6(r=0.554,P<0.01)、TNF-α(r=0.572,P<0.01)及iPTH(r=0.541,P<0.01)呈显著正相关,iPTH与IL-6(r=0.533,P<0.01)、TNF-α(r=0.516,P<0.01)呈显著正相关。结论 HD+HP可有效清除iPTH、IL-6、TNF-α及CRP,从而改善慢性肾功能衰竭继发性甲旁亢患者的微炎症状态、减轻临床症状;HDF亦能有效清除iPTH及IL-6、TNF-α,但清除效果不及HD+HP;HD不能有效清除IL-6、TNF-α、iPTH及CRP。

Hemoperfusion attenuates microinflammation state of secondary hyperparathyroidism: report of 60 cases

Objective To compare the effects of different dialysis modes,regular hemodialysis(HD),hemodiafiltration(HDF),and the combination of hemodialysis and hemoperfusion(HD+HP) on intact parathyroid hormone(iPTH) and microinflammation state of secondary hyperparathyroidism in patients with chronic renal failure.Methods A total of 60 patients with chronic renal failure who received maintenance hemodialysis and identified as microinflammation in our hospital during November 2011 to January 2012 were enrolled in this study.They were randomly assigned to above 3 treatments respectively for 3 months,with 20 patients in each group.Their blood samples were collected before and at the end of treatment for serum levels of IL-6,TNF-α,intact parathyroid hormone(iPTH) and C-reactive protein(CRP).Results The serum level of CRP was reduced significantly through dialysis in HD+HP group,while no significance was found in the HD and HDF groups.The serum levels of iPTH,IL-6 and TNF-α were reduced significantly through dialysis in HD+HP and HDF groups,while no significance was found in the HD group.The clearance of HD+HP group was higher than that of HDF group(P<0.05).The symptoms of osteodynia,myasthenia,skin itch,and angina pectoris were improved in HD+HP and HDF groups,much better than in HD group(P<0.05).Correlation analysis showed that serum CRP level was significantly positively correlated with IL-6(r=0.554,P<0.01) and TNF-α(r=0.572,P<0.01),and serum iPTH was significantly positively correlated with CRP(r=0.541,P<0.01),IL-6(r=0.533,P<0.01) and TNF-α(r=0.516,P<0.01).Conclusion HD+HP can efficiently eliminate the serum levels of IL-6,TNF-α,iPTH and CRP in secondary hyperparathyroidism patients with chronic renal failure,better than HDF and HD.and thus improve the microinflammation state and clinical manifestation.