血液透析、高通量血液透析及血液透析滤过治疗尿毒症患者的效果及对血清炎症因子、氧化应激指标的影响

目的探讨血液透析(conventional hemodialysis, CHD)、高通量血液透析(high flux hemodialysis, HFHD)及血液透析滤过(hemodia-filtration, HDF)治疗尿毒症患者的效果及对血清炎症因子、氧化应激指标的影响。方法选取2016年1月-2018年6月收治的134例行血液透析治疗的尿毒症患者,根据血液透析方法的不同分为CHD组48例、HFHD组46例和HDF组40例。比较3组治疗前、治疗6个月后肾功能指标[血尿酸(UA)、尿素(BUN)、血肌酐(SCr)],炎症因子[C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、淀粉样蛋白A(SAA)],血液净化相关指标[同型半胱氨酸(Hcy)、甲状旁腺素(PTH)、晚期糖基化终末产物(AGEs)],营养相关指标[白蛋白(Alb)、前白蛋白(PA)、血红蛋白(Hb)],氧化应激指标[晚期氧化蛋白产物(AOPP)、超氧化物歧化酶(SOD)、丙二醛(MDA)]水平。结果①治疗6个月后,3组UA、BUN、SCr均低于治疗前(P<0.01),但3组治疗后上述指标组间比较差异无统计学意义(P>0.05)。②治疗6个月后,3组CRP、SAA均低于治疗前,且HFHD组和HDF组降幅均大于CHD组,HDF组降幅大于HFHD组,差异均有统计学意义(P<0.05或P<0.01)。治疗6个月后,HFHD组和HDF组TNF-α均低于治疗前和同期CHD组(P<0.01)。③治疗6个月后,HFHD组和HDF组Hcy、PTH水平均低于治疗前(P<0.01),3组AGEs水平均低于治疗前(P<0.05或P<0.01);HFHD组和HDF组治疗6个月后Hcy、PTH、AGEs水平低于同期CHD组,且HDF组PTH降幅小于HFHD组,差异均有统计学意义(P<0.01)。④3组Alb治疗前后及组间比较差异均无统计学意义(P>0.05);治疗6个月后,3组PA均高于治疗前(P<0.01),HFHD组和HDF组Hb高于治疗前(P<0.01)。治疗6个月后HFHD组和HDF组Hb均高于CHD组(P<0.01),但HFHD组和HDF组组间比较差异无统计学意义(P>0.05)。⑤治疗6个月后,CHD组AOPP、MDA均高于治疗前,SOD低于治疗前,HFHD组和HDF组AOPP、SOD、MDA均低于治疗前,差异均有统计学意义(P<0.05或P<0.01);治疗6个月后,HFHD组和HDF组AOPP、MDA均低于CHD组,SOD均高于CHD组,且HDF组AOPP、MDA降幅大于HFHD组,SOD降幅小于HFHD组,差异均有统计学意义(P<0.05或P<0.01)。结论 HFHD和HDF用于尿毒症血液净化效果均优于CHD,且HDF在清除炎症因子、降低氧化应激方面更具优势。

Effects of Hemodialysis,High-flux Hemodialysis and Hemodiafiltration on Patients with Uremia and Its Influence on Serum Inflammatory Factors and Oxidative Stress Indexes

Objective To explore the effects of conventional hemodialysis(CHD),high-flux hemodialysis(HFHD)and hemodiafiltration(HDF)on patients with uremia and its influence on serum inflammatory factors and oxidative stress indexes.Methods A total of 134 patients with uremia undergoing hemodialysis from January 2016 to June 2018 were selected.Patients were divided into CHD group(n=48),HFHD group(n=46)and HDF group(n=40)according to different hemodialysis methods.Renal function indexes[uric acid(UA),blood urea nitrogen(BUN),serum creatinine(SCr)],inflammatory factors[C-reactive protein(CRP),tumor necrosis factorα(TNF-α),serum amyloid A(SAA)],blood purification related indicators[homocysteine(Hcy),parathyroid hormone(PTH),advanced glycation end products(AGEs)],nutritional related indicators[albumin(Alb),prealbumin(PA),hemoglobin(Hb)]and oxidative stress indexes[advanced oxidation protein products(AOPP),superoxide dismutase(SOD),malondialdehyde(MDA)]were compared among the three groups before treatment and at 6 months after treatment.Results①At 6 months after treatment,the UA,BUN and SCr in the three groups were lower than those before treatment(P<0.01),and there were no significant differences in above indicators between any two groups after treatment(P>0.05).②At 6 months after treatment,the CRP and SAA in the three groups were lower than those before treatment,and the reductions in HFHD group and HDF group were greater than those in CHD group(P<0.05 or P<0.01).At 6 months after treatment,the level of TNF-αin HFHD group and HDF group was lower than that before treatment and that in CHD group(P<0.01).③At 6 months after treatment,the Hcy and PTH levels in HFHD group and HDF group were lower than those before treatment(P<0.01),and the AGEs level in three groups was lower than that before treatment(P<0.05 or P<0.01).The Hcy,PTH and AGEs levels in HFHD group and HDF group at 6 months after treatment were lower than those in CHD group,and the reduction of PTH in HDF group was lower than that in HFHD group(P<0.01).④There was no significant difference in Alb among the three groups before and after treatment(P>0.05).At 6 months after treatment,the PA in the three groups was higher than that before treatment(P<0.01).The Hb in HFHD group and HDF group was higher than that before treatment(P<0.01).At 6 months after treatment,the Hb level in HFHD group and HDF group was higher than that in CHD group(P<0.01),but Hb level was not significantly different between HFHD group and HDF group(P>0.05).⑤At 6 months after treatment,the AOPP and MDA in CHD group were higher than those before treatment,the SOD was lower than that before treatment,and the AOPP,SOD and MDA in HFHD group and HDF group were lower than those before treatment(P<0.05 or P<0.01).At 6 months after treatment,the AOPP and MDA in HFHD group and HDF group were lower,while the SOD was higher than those in CHD group.In addition,the AOPP and MDA in HDF group were greater than those in HFHD group,while the reduction of SOD in HDF group was lower than that in HFHD group(P<0.05 or P<0.01).Conclusion HFHD and HDF have better blood purification than CHD in uremic patients.HDF is more advantageous in eliminating inflammatory factors and reducing oxidative stress.