不同血液净化方式对维持性血液透析患者微炎症状态和肾性贫血的影响

目的 探讨低通量血液透析（LFHD）与高通量血液透析（HFHD）对维持性血液透析（MHD）患者微炎症状态和贫血状态的影响.方法 选择2011年5月至2012年11月在新疆自治区人民医院血液净化中心行维持性血液透析（MHD）治疗的慢性肾脏病（CKD）5期患者共50例,随机分为LFHD组和HFHD组各25例,观察两组患者首次透析前和治疗3个月后（透析前）的血红蛋白、尿素氮、白细胞介素6（IL-6）、C反应蛋白（CRP）及β2微球蛋白（β2-MG）的变化并进行分析比较.结果 LFHD组与HFHD组首次透析前血红蛋白、尿素氮、IL-6、CRP及β2-MG比较差异均无统计学意义（P均＞0.05）;LFHD组首次透析前与透析3个月后尿素氮及IL-6比较差异均无统计学意义（P均＞0.05）,β2-MG（5.390 ±0.550）、（4.570±0.435）mg/L,t=5.848,P＜0.01]及CRP（1.160±0.205）、（2.516±0.211） mg/L,=22.147,P＜0.01]、血红蛋白（95.680±13.272）、（106.920±5.845） g/L,t=3.186,P＜0.01]比较差异均有统计学意义;HFHD组首次透析前与透析3个月后尿素氮比较差异无统计学意义,IL-6（24.470±18.043）、（12.170±7.863） ng/L,扛2.891,P ＜0.01]、β2-MG（5.740±0.893）、（3.850 ±0.541） mg/L,=5.530,P＜0.01]、CRP（1.092±0.220）、（1.479±0.211） mg/L,=5.329,P＜0.01]、血红蛋白（95.680±14.185）、（114.160±7.386） g/L,t =4.506,P＜0.01]比较差异均有统计学意义.LFHD组与HFHD组治疗3个月后尿素氮比较差异无统计学意义,IL-6（27.750±15.935）、（12.170±7.863） ng/L,t =4.382,P ＜0.01]、β2MG（4.570±0.435）、（3.850±0.541） mg/L,t =5.209,P＜0.01]、CRP（2.516±0.211）、（1.479±0.211） mg/L,t=15.580,P＜0.01]、血红蛋白（106.920±5.845）、（114.160±7.386）g/L,=3.843,P＜0.01]比较差异均有统计学意义.结论 HFHD较LFHD更能够有效清除中分子毒素和微炎症细胞因子,纠正MHD患者肾性贫血,从而显著改善MHD患者的微炎症状态和贫血状态.

The effect of different ways of blood purification on maintenance micro inflammation and renal anemia of hemodialysis patients

Objective To investigate the methods of low flux hemodialysis （LFHD） and high flux hemodialysis （HFHD） on maintenance micro inflammation and renal anemia in patients with hemodialysis （MHD）.Methods Fifty cases with choice chronic kidney disease（CKD） at stage 5 were selected as our subjects who were received hemodialysis in the Xinjiang Autonomous Region People＇s Hospital of MHD blood purification center from May 2011 to November 2012.They were randomly divided into LFHD and HFHD group and 25 cases for each group.The levels of the hemoglobin （Hb）,urea nitrogen （BUN）,Intedeukin-6 （IL-6）,creactive protein（CRP） and serum β2 microglobulin（β2MG） were measured before hemodialysis and after 3months treatment.Results There were no significant differences between LFHD and HFHD group in terms of Hb,BUN,IL-6,CRP and β2 MG before hemodialysis （P ＞ 0.05）.Compared to before hemodialysis,there were no significant difference in LFHD group at 3 months after hemodialysis in the terms of BUN and IL-6 （P ＞ 0.05）,while the levels of β2-MG,CRP and Hb of patient were significantly different（β2-MG：（（5.390 ± 0.550） mg/L vs.（4.570 ±0.435） mg/L,t =5.848,P ＜0.01 ;CRP：（1.160 ±0.205） mg/L vs.（2.516 ±0.211） mg/L,t =22.147,P ＜ 0.01 ;Hb：（95.680 ± 13.272） g/L vs.（106.920 ± 5.845） g/L,t =3.186,P ＜ 0.01）.The levels of IL-6,β2-MG,CRP and Hb of patients in HFHD groups at 3 months after hemodialysis were （12.170 ±7.863） ng/L,（3.850 ± 0.541） mg/L,（1.479 ± 0.211） mg/L,（114.160 ± 7.386） g/L respectively,significant different from that before hemodialysis （（24.470 ± 18.043） ng/L,（5.740 ± 0.893） mg/L,（1.092± 0.220） mg/L,（95.680 ± 14.185） g/L respectively,t =2.891,5.530,5.329,4.506,P ＜ 0.01）.At 3months after hemodialysis,there was no significant difference between the two groups in the term of BUN,while the levels of IL-6,β2-MG,CRP,Hb of patients were significant different between the two groups（IL-6：（27.750± 15.935） ng/L vs.（12.170 ±7.863） ng/L,t =4.382,P ＜0.01 ;β2MG：（4.570 ±0.435） mg/L vs.（3.850±0.541） mg/L,t=5.209,P＜0.01;CRP：（2.516±0.211） mg/L vs.（1.479±0.211） mg/L,t =15.580,P＜0.01,Hb：（106.920±5.845） g/Lvs.（114.160±7.386） g/L,t=3.843,P＜0.01）.Conclusion HFHD is proved to be more effectively than LFHD in terms of clearing micro molecular toxins and inflammatory cytokines in renal anemia,and thus significantly improve the micro inflammation state and anemia in patients with MHD.