高通量血液透析对维持性血液透析患者免疫功能的影响

目的 探讨高通量血液透析对维持性血液透析患者体液免疫及细胞免疫功能的影响。方法 选择维持性血液透析患者60例，按随机数字表法分为常规透析组（C组）和高通量血液透析组（T组），每组30例，治疗时间为12周，另选择20例健康成年体检者作为对照组（N组），监测治疗前后患者外周血免疫球蛋白、补体C3、C4以及T细胞亚群的变化，同时观察患者治疗前后感染例次的变化。结果 C组患者治疗后外周血免疫球蛋白、补体C3、C4以及T细胞亚群水平较治疗前无明显变化，而T组患者治疗后外周血IgG、IgA、IgM、C3、C4、CD3+、CD4+、CD4+/CD8+水平较治疗前明显升高(12.20±3.98) g/L比(6.18±1.45) g/L,( 1.89±0.58) g/L比(0.63±0.15)g/L,(1.29±0.47) g/L比(0.51±0.13) g/L，(0.94±0.36) g/L比(0.58±0.20)g/L，(0.28±0.06) g/L比(0.11±0.04)g/L，(63.11±9.43)％比(53.26±9.08)％,(38.21±6.15)％比(31.56±6.02)％,1.48±0.37比1.25±0.43]（P值均＜ 0.05），且与C组患者治疗后比较，差异均有统计学意义(P＜0.05)。T组患者治疗后感染例次较治疗前明显降低46.7％(14/30)比133.3％(40/30)，P＜0.05]，而C组患者治疗后感染例次较治疗前无明显变化126.7％(38/30)比136.7％(41/30)，P＞0.05]。结论 高通量血液透析可以改善维持性血液透析患者的细胞免疫及体液免疫功能，降低感染率。

Effect of high-flux hemodialysis on immune state in maintenance hemodialysis patients

Objective To study the changes of serum immune state in maintenance hemodialysis (MHD) patients with high-flux hemodialysis. Methods Sixty MHD patients were divided into high-flux hemodialysis group (group T, 30 cases, receiving high-flux hemodialysis, 3 times per week and routine drug therapy) and conventional dialysis group (group C, 30 cases, taking conventional dialysis, 3 times per week and routine drug therapy) by random number table. They were treated for 12 weeks. Serum IgG,IgA, IgM,C3, C4, T lymphocyte subsets and albumin, prealbumin, hemoglobin were detected at the experiment onset and 12 weeks later, and compared with those of 20 normal medical examination adults (group N ), meanwhile the ratio of infection was calculated. Results The levels of IgG,IgA,IgM,C3,C4,CD3+,CD4+,CD4+/CD/8+ in group C had no significant changes before and after treatment (P ＞ 0.05 ), but there were significant changes in group T(12.20 ± 3.98) g/L vs.(6.18± 1.45) g/L, (1.89 ±0.58) g/L vs. (0.63 ±0.15) g/L, (1.29 ± 0.47)g/L vs. (0.51 ± 0.13) g/L, (0.94 ± 0.36) g/L vs.(0.58 ± 0.20) g/L, (0.28 ± 0.06) g/L vs. (0.11 ± 0.04) g/L,(63.11 ± 9.43 )％ vs. (53.26 ± 9.08 )％, ( 38.21 ± 6.15 )％ vs. ( 31.56± 6.02 )％, 1.48 ± 0.37 vs. 1.25 ± 0.43](P＜ 0.05), and there were significant differences between group T and group C after treatment (P＜ 0.05).The ratio of infection in group T was decreased obviously 46.7％ (14/30) vs. 133.3％ (40/30), P ＜ 0.05], but there was no significant difference in group C 126.7％(38/30) vs. 136.7％(41/30),P＞ 0.05]. Conclusion High-flux hemodialysis can improve the immune state and the nuuitional state in MHD patients, and it could decrease the infection rate.