高通量血液透析对尿毒症患者微炎症及营养不良的影响

目的探讨高通量血液透析对尿毒症患者微炎症及营养不良的影响。方法前瞻性选取2017年3月至2019年6月中国人民解放军联勤保障部队第九四二医院收治的尿毒症血液透析患者86例,采用随机数字表法将患者分为高通量透析组(HFHD组)和常规透析组(HD组),每组各43例。HFHD组采用高通量透析治疗,HD组采用传统透析治疗。比较两组患者透析治疗6个月后血清肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)和白细胞介素-6(IL-6)水平变化,并进行营养状况评估。结果治疗前,两组患者的血清TNF-α、hs-CRP、IL-6水平比较(41.53±6.32 ng/L vs.40.84±8.21 ng/L;7.45±1.23 mg/L vs.7.37±1.12 mg/L;26.41±5.98 ng/L vs.25.98±4.71 ng/L),差异无统计学意义(t=0.475、0.783、0.572;P>0.05);治疗6个月后,HFHD组患者的血清TNF-α、hs-CRP、IL-6水平显著低于HD组(29.31±4.87 ng/L vs.37.44±6.02 ng/L;4.71±0.76 mg/L vs.6.12±0.94 mg/L;17.34±3.74 ng/L vs.21.33±4.51 ng/L),差异具有统计学意义(t=4.812、5.982、4.331;P=0.002、<0.001、0.011)。治疗前,两组患者营养不良的比率比较(53.49%vs.55.81%),差异均无统计学意义(χ^2=0.046,P=0.828),治疗6个月后,HFHD组患者营养不良的比率显著低于HD组(18.60%vs.44.19%),差异具有统计学意义(χ^2=6.532,P=0.010)。结论高通量血液透析较常规的低通量血液透析有明显的优点,在改善尿毒症患者的微炎症状态与营养状况方面具有一定优势。

Effect of high-flux hemodialysis on microinflammation and malnutrition in uremia patients

Objective To investigate the effect of high-flux hemodialysis on microinflammation and malnutrition in uremia patients.Methods 86 cases of uremia hemodialysis patients treated in China People's Liberation Army Joint Support Unit No.942 Hospital from March 2017 to June 2019 were prospectively selected and the subjects were randomly divided into a high-flux hemodialysis group(HFHD group)and a conventional hemodialysis group(HD group)according to random number table methods,with 43 cases in each group.HFHD group was treated with high-throughput dialysis,and HD group was treated with traditional dialysis.Changes in serum Tumor Necrosis Factor-α(TNF-α),hypersensitive C-reactive protein(hs-CRP)and Interleukin-6(IL-6)levels were compared before and after 6 months of hemodialysis treatment,and nutritional status was also evaluated.Results There was no statistical difference in serum TNF-α,hs-CRP and IL-6(41.53±6.32 ng/L vs.40.84±8.21 ng/L;7.45±1.23 mg/L vs.7.37±1.12 mg/L;26.41±5.98 ng/L vs.25.98±4.71 ng/L)before treatment between the two groups(t=0.475,0.783,0.572,P>0.05).After 6 months of treatment,the levels of serum TNF-α,hs-CRP and IL-6(29.31±4.87 ng/L vs.37.44±6.02 ng/L;4.71±0.76 mg/L vs.6.12±0.94 mg/L;17.34±3.74 ng/L vs.21.33±4.51 ng/L)were significantly lower than those in the control group(t=4.812,5.982,4.331,P=0.002,<0.001,0.011).There was no statistical difference in the proportion of malnutrition(53.49%vs.55.81%)before treatment in the two groups(χ^2=0.046,P=0.828).After 6 months of treatment,the proportion of malnutrition in the HFHD group was significantly lower than that in the HD group(18.60%vs 44.19%)with a statistically significant difference(χ^2=6.532,P=0.010).Conclusion High-flux hemodialysis has obvious advantages over conventional low-throughput hemodialysis in improving patients'micro-inflammatory and nutritional status.