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。

Effect of high-flux hemodialysis on cellular immunity in patients receiving maintenance hemodialysis

Objective To investigate the effect of high-flux hemodialysis on cellular immunity in patients receiving maintenance hemodialysis （MHD）. Methods Forty outpatients in our hospital scheduled for MHD between March and August 2012 were recruited and assigned to be treated with hemodialysis （group HD; n=20） andhigh-flux hemodialysis （group HFHD, n=20） by random number table for 3 consecutive 4- hour courses per week. Peripheral blood CD4＋, CD8＋, CD25＋ and CDg＋/CD8＋ ratio were assayed by flow cytometry, and the levels of serum IL-2 and sIL-2R were detected by enzyme-linked immunosorbent assayprior to and 4, 24 and 48 h after dialysis. Twenty healthy subjects （group C） were subjected to the aforementioned measurements from the morning blood samples. R＋ults Compared with group C, substantially lower levels of peripheral blood CD4＋, CD25＋, CD4＋/CD8＋ ratio and serum IL-2 yet higher levels of serum sIL-2R were noted in HD and HFHD group prior to MHD （all P〈0.05）. Compared with the levels prior to MHD, 4 h after hemodialysis in group HD resulted in increased level of peripheral blood CD4＋, CD25＋, CD4＋/CD8＋ ratio and serum IL-2 yet reduced serum sIL-2R （all P〈0.05） , while the difference in CD8＋ was unremarkable （P〉0.05）. The difference in the aforementioned indices in group HD measured at 24 and 48 h after hemodialysis, as compared with those prior to MHD, was not statistically significant （all P〉O.05）. Compared with the levels assayed prior to MHD, patients in group HFHD yielded markedly higher levels of peripheral blood CD4＋, CD25＋, CD4＋/CD8＋ ratio and serum IL-2 yet reduced levels of serum sIL-2R at 4, 24 and 48 h after hemodialysis （all P〈0.05） , while the difference in CD8＋ was unremarkable （all P〉0.05）. Group HD did not differ substantially with group HFHD in the aforementioned indices at 4 h after hemodialysis （all P〉0.05）. Compared with group HD, group HFHD was characterized by considerably higher levels of peripheral blood CD4＋, CD25＋, CDd＋/CD8＋ ratio and serum IL-2 yet lower levels of serum sIL-2R CD4＋ ： （38.75±6.25）% vs （34.92±5.84）% at 24 h and （57.05±5.41）% vs （52.62±5.79）% at 48 h after dialysis; CD25＋ （21.36±4.65）% vs （15.29±4.72）% at 24 h and （18.19±4.27）% vs （13.94±5.05）% at 48 h after dialysis; CD4＋/CD8＋ ： 1.42±0.31 vs 1.23±0.29 at 24 h and 1.38±0.30 vs 1.20± 0.33 at 48 h after dialysis; IL-2： （22.03±5.18）mg/L vs （ 19.03±4.87）mg/L at 24 h and （20.54±5.92）mg/L vs （18.26±4.96） mg/L at 48 h after dialysis; sIL-2R： （672.96＋ 159.36）U/ml vs （787.32± 143.27）U/ml at 24 h and （720.24±143.92）U/ml vs （858.42±172.13）U/ml at 48 h after dialysis, all P〈0.05], while the CD8＋ did not differ statistically at both time points （both P〉0.05）. Conclusion HD may temporarily whilst HFHD may persistently improve cellular immunity in patients receiving MHD.