高通量血液透析对维持性血液透析患者细胞免疫功能的影响

目的探讨高通量血液透析对维持性血液透析（MHD）患者细胞免疫功能的影响。方法收集2012年3月至8月于本院门诊行MHD治疗的患者40例,随机数字表法分为血液透析（HD）组（n=20）和高通量血液透析（HFHD）组（n=20）,分别接受HD和HFHD治疗,均为每周透析3次,每次4h。透析前、透析后4、24、48h,流式细胞术检测两组患者外周血CD4＋．CD8＋、CD25＋,记录CD47CD8＋比值,酶联免疫吸附测定（ELISA）检测血清IL-2、可溶性IL-2受体（sIL．2R）;另设健康对照组（C组）20例,清晨空腹抽血检测上述指标。结果与C组比较,透析前HD组和HFHD组患者外周血CD4＋、CD25＋、CD4＋／CD8＋水平下降,血清IL．2水平下降,sIL．2R升高（均P〈0．05）。与透析前比较,HD组患者透析后4h外周血CD4＋、CD25＋、CD47CD8＋水平升高,血清IL-2水平升高,sIL-2R降低（均P〈0．05）,CD8＋差异无统计学意义（P〉O．05）;与透析前比较,HD组患者透析后24、48h上述各指标差异无统计学意义（均P〉0．05）。与透析前比较,HFHD组患者透析后4、24、48h外周血CD4＋、CD25＋、CD4VCD8＋水平升高,血清IL．2水平升高,slL-2R降低（均P〈0．05）,而CD8＋差异均无统计学意义（均P〉O．05）。与同时点HD组比较,HFHD组透析后4h各指标差异均无统计学意义（均P〉O．05）;透析后24、48h,HFHD组外周血CD4＋、CD25＋、CD4＋／CD8＋水平升高,血清IL．2水平升高,sIL．2R降低[CD4＋：（38．73±6．25）％比（34．92±5．84）％,（37．03±5．41）％比（32．62±5．79）％;CD25＋：（21．36±4．65）％比（15．29±4．72）％,（18．19±4．27）％比（13．94±5．05）％;CD4＋／CD8＋：1．42±0．31比1．23±0．29,1．38±0．30比1．20±0．33;IL-2：（22．03±5．18）m±L比（19．03±4．87）m#L,（20．54±5．92）mL比（18．26±4．96）mL;sIL-2R：（672．96±159．36）U／ml比（787．32±143．27）u,ml,（720．24±143．92）u,（858,42±172．13）U／ml,均P〈0．05],而CD8＋差异无统计学意义（均P〉O．05）。结论HD可短暂改善MHD患者的细胞免疫功能,HFHD可持续改善MHD患者的细胞免疫功能。     

维持性血液透析患者透析间期的观察与护理

在治疗尿毒症患者身体疾病的同时关注其心理健康，改善其生活质量是维持血液透析患者的理想目标，如何促进这一目标的实现是血透室医护人员面临的一个重要问题，加强对血液透析（HD）患者透析间期的密切观察和个体化护理是降低透析间期并发症，保证HD过程平稳，提高HD患者远期生存质量的有效措施。 1临床资料 我院2003年3月～2005年12月维持性血液透析患者52例，男性30例，女性22例，其中多囊肾3例，糖尿病肾病7例，慢性肾小球肾炎20例，慢性肾盂肾炎22例，HD治疗3个月～31个月，平均17个月，HD治疗次数2—3次／周，个别患者1次／周，48例病人存在肾性高血压，血压经药物控制在100～140／60-90mmHg之间，4例患者血压正常均有肾性贫血，Hb维持在70～120∥L，HD后无明显水肿，HD过程发生低血压占30％，高血压占40％，头痛占5％，恶心呕吐约占5～15％，皮肤瘙痒占5％。     

尿毒症患者透析前后心钠素水平的观察

本文报道32例尿毒症患者血液透析前后心钠素水平的变化，并就临床意义作初步讨论，现报道如下。     

血液透析联合血液灌流治疗维持性透析患者钙磷代谢紊乱的疗效观察

目的：分析血液透析联合血液灌流的作用,并探讨对维持性透析患者钙磷代谢紊乱的疗效。方法：以本单位2015年全年收治的进行维持性血液透析的患者100例为受试对象,随机分为实验组(50例)和对照组(50例),对照组仅接受血液透析治疗;实验组进行血液透析的基础上联合血液灌流治疗。比较两组患者透析前、透析后2、3、4个月尿素氮(BUN)、肌酐(Scr)、补体C3、β2微球蛋白(β2-MG)、血磷(P)、钙磷乘积、血清全段甲状旁腺激素(iPTH)、维生素D3(1,25(OH)D3)的水平,比较两组患者血清白蛋白(Alb)、胆固醇(TC)、血红蛋白(Hb)、红细胞水平(RBC),并分析其临床意义。结果：两组患者透析后各时间段BUN、Scr水平均较透析前显著降低,补体C3水平则在透析4个月后显著升高;而两组患者透析后各时间段肾功能评价指标无显著差异;实验组各时间段钙磷代谢指标较透析前和对照组显著改善;实验组透析后3、4个月营养状况较透析前、对照组均有所改善,对照组营养状况无显著差异。结论：血液透析联合血液灌流有助于维持性血液透析患者体内毒素的清除,纠正钙磷代谢紊乱,改善患者营养状况,值得推广使用。     

维持性血液透析患者血栓前状态标志物变化及临床意义

目的:探讨终末期肾衰竭维持性血液透析患者血栓前状态标志物的变化.方法:59例维持性血液透析患者,血液透析前采静脉血4.5ml,30名健康志愿者作为对照组,清晨空腹采静脉血4.5ml,用ELISA测定血浆凝血酶-抗凝血酶复合物(TAT)、纤维蛋白肽A(FPA)、蛋白C(PC)、血管性血友病因子(vWF)、P-选择素(P-Selectin)、血栓前体蛋白(TpP)、D-二聚体(DD)含量.结果:与健康对照组相比,维持性血液透析患者组血浆TpP、TAT、vWF、FPA、DD显著升高(P＜0.05);P-选择素、PC显著下降(P＜0.01).结论:终末期肾衰竭维持性血液透析患者存在血栓前状态标志物异常,提示可能存在血栓前状态.     

血液透析和腹膜透析对男性肾性贫血患者睾酮水平和贫血状态的影响

目的:分析血液透析(HD)和腹膜透析(PD)对不同时间终末期肾脏病(ESRD)患者睾酮和肾性贫血的影响。方法:2015-01-01—2016-12-31在本院进行透析治疗患者64例,按其透析方式分为HD组和PD组,各32例,分别比较两组患者透析前、透析3个月、透析6个月后血清总睾酮、游离睾酮和透析前、透析6个月后血红蛋白(Hb)、红细胞计数(RBC)、红细胞比容(Hct)水平变化。结果:透析前两组患者总睾酮、游离睾酮、Hb、RBC、Hct水平均无统计学差异(P0.05),随着透龄增加,PD组患者总睾酮、游离睾酮逐渐增加,PD 3—6个月后显著高于HD组;PD 6个月后患者贫血状态得到有效纠正,其Hb、RBC、Hct升高,明显优于HD组(P0.05)。结论:PD 3个月可明显升高男性ESRD患者血清睾酮水平,纠正肾性贫血,效果优于HD。     

高通量透析膜对维持性血液透析过程中溶质清除及皮肤瘙痒的作用

背景：如何有效地清除尿毒症毒素,以减少透析患者的并发症,改善维持性血液透析患者生活质量及长期预后,一直是人们研究的热点。 目的：观察高通量和低通量聚砜膜血液透析器对维持性血液透析患者溶质清除及皮肤瘙痒的作用。 方法：选择皮肤瘙痒的维持性血液透析患者38例,随机分为高通量透析组和低通量透析组,每组19例。高通量透析组使用高通量透析器FX60,低通量透析组使用低通量透析器F6,均每周透析3次,每次透析4 h,观察1年;检测血尿素氮、肌酐、磷、β2微球蛋白及甲状旁腺素;观察透析前后各种溶质含量的变化,计算溶质清除率和尿素清除指数(Kt/V值);用目测类比评分法评估瘙痒程度。 结果与结论：两组患者透析后尿素氮、肌酐下降率差异无显著性意义(P > 0.05),磷和β2微球蛋白的下降率高通量透析组均高于低通量透析组(P < 0.05),两组Kt/V相比差异无显著性意义(P > 0.05);治疗1年后高通量透析组甲状旁腺素显著低于低通量透析组(P< 0.05),皮肤瘙痒与治疗前相比两组均有减轻(P< 0.05),高通量透析组瘙痒程度评分显著低于低通量透析组(P < 0.05)。提示采用高通量FX60聚砜膜透析器进行透析,不仅充分清除小分子毒素,而且增加了对于大、中分子毒素的清除,能改善维持性透析患者顽固性皮肤瘙痒症状。     

探讨组合型人工肾对维持性透析患者生活质量的影响

如今全球尿毒症患者的数量在逐年增长,每年大<有98万尿毒症患者需通过血液透析的方式来维持生命,但常用的单纯血液透析方式只对肌酐、尿素等小分子水溶性毒素的清除较为有效,而对于大中分子毒素的清除效果较差,导致患者出现肾性骨病、高血压等并发症,严重影响患者的治疗效果和生活质量。本文对利用血液透析联合血液灌流(HD+HP)的透析模式对尿毒症患者的治疗效果进行综述,对患者生活质量的影响做简要的研究。     

老年腹膜透析与维持性血液透析患者微炎症状态的比较

目的比较老年腹膜透析与血液透析患者体内微炎症状态的差异。方法选取23例老年腹膜透析及24例维持性血液透析患者,测定并比较两组患者血清高敏C反应蛋白（hs-CRP）、白介素6（IL一6）和肿瘤坏死因子（TNF-α）水平。结果老年腹膜透析患者血清hs-CRP、IL一6和TNF-α水平较维持性血液透析患者低（P〈0.05）。结论老年腹膜透析患者微炎症反应比维持性血液透析患者轻。     

尿毒症及透析患者血浆IL-1β、TNFα、IL-6水平及其意义

目的　研究尿毒症状态和血液透析对血浆细胞因子的影响。方法　应用酶联免疫吸附分析(ELISA)方法检测正常人、尿毒症未透析患者、腹膜透析患者和应用铜仿膜、聚砜膜、聚甲基丙烯酸甲酯膜(PMMA)血液透析患者血浆IL-1β、TNFα、IL-6水平。结果　尿毒症未透析患者血浆TNFα、IL-6水平显著高于正常对照(P<0.05)。在应用不同透析膜15分钟时,血浆细胞因子水平较透析前有不同程度的降低,聚砜膜透析时IL-1β、TNFα降低明显,统计学差异显著(P<0.05)。应用三种透析膜透析时细胞因子无显著性差异。结论　尿毒症未透析状态可导致激活外周血单核细胞(PBMC)产生细胞因子,不同透析膜透析时激活PBMC及吸附、清除细胞因子的程度不同,单纯用细胞因子的血浆水平变化来评价透析膜的生物相容性存在一定局限性。     

待肾源移植透析者连续性肾脏替代治疗对顽固性高血压的影响

背景：维持性血液透析人群中有10%-49%的患者合并顽固性高血压,常规药物治疗效果差。连续性肾脏替代治疗可较好地清除患者血浆中的中、大分子毒素,理论上可通过降低相关毒素水平干预顽固性高血压形成机制。 目的：观察连续性肾脏替代治疗对维持性血液透析患者顽固性高血压的影响。 方法：45例维持性血液透析合并顽固性高血压患者,随机分为血液透析组22例与连续性血液净化组23例,血液透析组则行常规血液透析治疗,连续性肾脏替代治疗组在常规血液透析治疗基础上每周行连续性肾脏替代治疗1次。 结果与结论：治疗3个月后,连续性血液净化组肾素、内皮素、血管紧张素Ⅱ、C-反应蛋白、白细胞介素6、肿瘤坏死因子α水平均低于试验前水平,24 h平均血压下降,且差异均有显著性意义(P < 0.05),血液透析组上述各指标较试验前无变化(P > 0.05);试验后连续性血液净化组上述各指标均低于血液透析组,差异有显著性意义(P < 0.05)。结果显示在常规血液透析基础上行连续性肾脏替代治疗可明显降低合并顽固性高血压维持性血液透析患者的血压,其机制可能是降低了患者血浆中的中、大分子毒素以及炎症因子水平。 中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程全文链接：     

维持性血液透析患者微炎症状态对促红细胞生成素疗效的影响

目的：探讨在维持性血液透析(maintenance hemodialysis,MHD)患者中微炎症状态对重组人促红细胞生成素(recombinant human erythropoietin,r-HuEPO)治疗肾性贫血的影响。方法：53例患者根据血清超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)的水平分为微炎症组(hs-CRP>3 mg/L,n=30)和非炎症组(hs-CRP≤3 mg/L,n=23),测定血红蛋白(hemoglobin,Hb)、血细胞比容(hematocrit,Hct)、r-HuEPO的用量[U/(kg.week)]与Hct的比值(EPO/Hct)、hs-CRP、血清肌酐(serum creatinine,Scr)、血清铁蛋白(serum ferritin,SF)、转铁蛋白饱和度(transferrin saturation,TS)、血清白蛋白(albumin,Alb)、尿素清除指数(urea remove index,KT/V)和全段甲状旁腺激素(intact parathyroid hormone,iPTH)的水平,采用独立样本t检验比较两组间的差异;以EPO/Hct作为EPO反应性的指标,对影响EPO反应性的指标进行多因素分析。结果：微炎症组hs-CRP升高,非炎症组正常,微炎症组的hs-CRP水平显著高于非炎症组(P<0.01),微炎症组的年龄、EPO/Hct水平显著高于非炎症组(P<0.05);多元相关性分析显示EPO反应性(EPO/Hct)与hs-CRP (r=0.538,P<0.01)、 KT/V(r=0.277,P<0.05)呈显著正相关,与Alb(r=-0.605,P<0.01)和Scr(r=-0.291,P<0.05)呈显著负相关;多元逐步回归分析显示,hs-CRP和白蛋白是影响EPO反应性的相关危险因素(R2=0.424,P<0.01)。结论：MHD患者存在微炎症状态,微炎症状态是影响MHD患者r-HuEPO反应性的重要因素。     

个体及集体干预对维持性血液透析患者生存质量的影响

背景：随着血液透析技术的不断改进,维持性血液透析患者的长期生存率亦不断上升,如何提高其生存质量,已经引起患者乃至全社会的广泛关注,也逐渐成为综合评价透析效果的可靠指标。 目的：探讨个体化干预与集体化干预对维持性血液透析患者生存质量的影响。 方法：选择透析时间大于3个月的维持性血液透析患者80例,采用随机数字表法分为试验组和对照组,每组40例。对照组患者在血液透析常规护理的基础上,按预先制定的周计划进行个体化护理干预,为期6周;试验组患者在对照组干预基础上,按预先制定的周计划进行集体化护理干预,为期6周。干预前后,均采用简明健康状况调查表(MOS 36-item short form health survey,SF-36)和终末期肾脏疾病透析患者调查简表(kidney disease quality of life short form,KDQOL-SFTM)评价2组患者生存质量变化。 结果与结论：干预后2组患者SF-36及KQQOL-SF评分均高于干预前(P < 0.01);试验组患者SF-36体能影响、整体健康、情感状态、情感影响、社会功能、精力等6个维度评分高于对照组干预后水平(P < 0.01);试验组患者KQQOL-SF社交质量、睡眠、社会支持、患者满意度4个维度评分高于对照组同期水平(P < 0.01)。提示个体化干预及在个体化干预基础上进行集体化干预均能提高维持性血液透析患者的生存质量,同时后者能从生理、心理、社会等多个方面更好的改善患者生存质量。     

Liver enzymes in patients with chronic kidney disease undergoing peritoneal dialysis and hemodialysis

OBJECTIVE:

The present study was designed to analyze the serum levels of aspartate and alanine aminotransferases, gamma-glutamyl transferase, and the hematocrit in patients with chronic kidney disease who were undergoing peritoneal dialysis or hemodialysis.

PATIENTS AND METHODS:

Twenty patients on peritoneal dialysis and 40 on hemodialysis were assessed, and the patients were matched according to the length of time that they had been on dialysis. Blood samples were collected (both before and after the session for those on hemodialysis) to measure the enzymes and the hematocrit.

RESULTS:

In the samples from the patients who were undergoing peritoneal dialysis, the aspartate and alanine aminotransferase levels were slightly higher compared with the samples collected from the patients before the hemodialysis session and slightly lower compared with the samples collected after the hemodialysis session. The levels of gamma-glutamyl transferase in the hemodialysis patients were slightly higher than the levels in the patients who were undergoing peritoneal dialysis. In addition, the levels of aminotransferases and gamma-glutamyl transferase that were collected before the hemodialysis session were significantly lower than the values collected after the session. The hematocrit levels were significantly lower in the patients who were on peritoneal dialysis compared with the patients on hemodialysis (both before and after the hemodialysis session), and the levels were also significantly lower before hemodialysis compared with after hemodialysis.

CONCLUSION:

The aminotransferase levels in the patients who were undergoing peritoneal dialysis were slightly higher compared with the samples collected before the hemodialysis session, whereas the aminotransferase levels were slightly lower compared with the samples collected after the session. The hematocrits and the aminotransferase and gamma-glutamyl transferase levels of the samples collected after the hemodialysis session were significantly higher than the samples collected before the session. Taken together, the present data suggest that hemodilution could alter the serum levels of liver enzymes.     

Effect of maintenance hemodialysis on diastolic left ventricular function in end-stage renal disease

PURPOSE:

To analyze the effect of maintenance hemodialysis on left ventricular diastolic function in patients with end‐stage renal disease.

METHODS:

Study population consisted of 42 patients with end‐stage renal disease. Before an arteriovenous fistula was surgically created, the patients were evaluated by conventional and Doppler echocardiography and Doppler tissue imaging. Then, the patients undergoing hemodialysis treatment when the arteriovenous fistula was compleated. After the first hemodialysis session (mean 76.14 ± 11.37 days) the second echocardiographic evaluations were performed.

RESULTS:

Mean age was 58 ± 13 years and 21 (%50) of the patients were female. After maintenance hemodialysis treatment; peak early (E) and peak late (A) diastolic mitral inflow velocities and E/A ratio were not significantly change however the deceleration time of E wave and left atrial diameter were significantly increased. Also there was no change in the early (Em) and late (Am) diastolic myocardial velocities and Em/Am ratios of lateral and septal walls of left ventricular. E/Em ratio was decreased insignificantly. Pulmonary vein velocities and right ventricular functions are remained almost unchanged after hemodialysis treatment.

DISCUSSION:

The acute and long‐term effect of hemodialysis on left ventricular diastolic function is unclearly. Patients with end‐stage renal disease treatment with hemodialysis via arteriovenous fistula experience a variety of hemodynamic and metabolic abnormalities that predispose to alterations in left and right ventricular functions. The present study showed that left ventricular diastolic function except left atrial diameter and right ventricular functions were not significantly change, however left ventricular systolic functions were impaired after maintenance hemodialysis treatment in patients with end‐stage renal disease.

CONCLUSION:

It has been suggested that echocardiographic parameters are useful markers for evaluation of left ventricular and right ventricular functions in patients with end‐stage renal disease. However, in patients with end‐stage renal disease treated with hemodialysis, repeated assessment of echocardiographic examinations to observe serial changes in left and right ventricular functions are not yet well established. In this study, we showed that acute changes of volume status and electrolytes and autonomic regulation by hemodialysis session did not affect left ventricular diastolic and right ventricular functions in a relatively long term.     

Hemopoietic effect of extracts from constituent herbal medicines of Samul-tang on phenylhydrazine-induced hemolytic anemia in rats

Samul-tang (Si-Wu-Tang, SMT), a kind of herbal medicines, has been used for the hemato-deficient disease for hundreds of years. In this work, investigate the anti-anemia activity of the H₂O extracts from constituent herbal medicines of Samul-tang in an anemia model induced by intravenous infection of phenylhydrazine-HCL (PHZ) at 10 mg/kg for 4 days. After PHZ injection, female Sparague-Dawley rats were administrated extracts from constituent herbal medicines of SMT (300 mg/kg/day, p.o.) daily for 1 week. Results showed that sever hemolysis was induced by PHZ. For Paeonia lactiflora (PL2) H₂O extract treated groups, the concentration of hemoglobin, hematocrit and red blood cells number increased much more significantly than PHZ-treated group. Moreover, Angelica gigas (AG), Angelica. acutiloba (AA), Paeonia lactiflora (PL2) and Rehmannia glutinosa (RG) extract administration significantly improved serum erythropoietin concentration. The activity of aminolevulinic acid dehydrates (ALDL) in liver homegenate was increased in Angelica gigas(AA), Paeonia lactiflora (PL2) and Rehmannia glutinosa (RG) treated group.     

Comparison of anthropometric data between end-stage renal disease patients undergoing hemodialysis and healthy adults in Korea

Protein-calorie malnutrition is prevalent in hemodialysis (HD) patients. The prevalence of obesity in healthy Korean adults has increased rapidly during the last 10 years. However, there are few large scale data collections available about the current weight status of Korean HD patients. The weight statuses of 10,304 HD patients (data from the Insan Memorial Dialysis Registry 2002, Korean Society of Nephrology) were compared to those of 12,436 control subjects (age > 18) by using body mass index (BMI). Weight status was assessed by WHO classification for Asian-Pacific region [underweight (UW): < 18.5; normal weight (NW): 18.5-22.9; overweight (OW): 23-24.9; obese (OB): 25-29.9; and extremely obese (EOB): > 30 kg/m2] in both the control and HD patients. HD patients had significantly lower body weight and BMI than the controls in all age groups and in both sexes. For the male controls, the proportions of OW and OB showed a reversed U-shape, peaking at the 5th and 6th decades. of the numbers of those classified as NW and UW were relatively small. For the female controls, the proportions of OW and OB progressively increased with age. On the contrary, in HD patients, the proportions of NW and UW were large, up to more than 70%, and those of OW and OB were small in both sexes. In each age group, UW was seen significantly more in the HD group than in the control group. The 6th decade age group showed the highest prevalence ratio for UW in the HD group for both sexes, compared to the controls (Male: 17.33, Female: 17.68). The percentages of UW were related to HD duration and age in both sexes. In conclusion, Korean HD patients seem to have small proportions of OW and OB, compared to the general population, and protein-calorie malnutrition may still be an important nutritional condition.     

Personality and patient adherence: Correlates of the five-factor model in renal dialysis

The five-factor taxonomy of personality traits has received increasing attention in the literature regarding personality correlates of health outcomes and behaviors. We examined the association of the five NEO Five-Factor Inventory dimensions to medical regimen adherence in a sample of 72 renal dialysis patients. Results indicated that Conscientiousness (Dimension III) is a five-factor trait significantly associated with adherence to the medication regimen. No other NEO-FFI dimension was significantly associated with patient adherence.