不同血液净化方式对尿毒症透析患者血中细胞因子清除的临床应用

目的 研究不同血液净化方式对尿毒症透析患者血中细胞因子的清除效果.方法 将2006年4月至2009年2月在我院血液净化中心透析的45例患者按随机数字表法分为(1)血液透析联合血液灌流组;(2)血液透析滤过组;(3)HD组,血液透析组,每组15例.血液透析联合血液灌流组、血液透析滤过组每周治疗1次,每组患者治疗3次,中间间隔1周,第1次及第3次治疗前、后各从动脉端采血5 ml,并留取正常健康对照组血液,整批送检.测定治疗前、后血清细胞因子的浓度.结果 血液灌流联合血液透析组、血液透析滤过组及血液透析组治疗前、后白细胞介素1β、白细胞介素6、肿瘤坏死因子α浓度与健康对照组比较差异有统计学意义(P＜0.01);血液透析组患者血肿瘤坏死因子α、白细胞介素1β、白细胞介素6水平分别为(3±10)ng/L、(4±9)ng/L、(4±9)ng/L,治疗前、后差值比较分别为176.0%、141.0%、187.0%,血液透析滤过组血肿瘤坏死因子α、白细胞介素1β、白细胞介素6水平分别为(39±15)ng/L、(36±14)ng/L、(45±16)ng/L,治疗前后差值比较分别为24.6%、22.1%、29.8%,血液灌流联合血液透析组血肿瘤坏死因子α、白细胞介素1β、白细胞介素6水平分别为(48±16)ng/L、(38±15)ng/L、(50±14)ng/L,治疗前差值比较分别为27.8%、23.9%、32.3%,3组患者血肿瘤坏死因子α、白细胞介素1β、白细胞介素6水平间比较差异有统计学意义(t分别=17.39、11.24、21.89,P均＜0.01).结论 不同的血液净化方式对各类细胞因子的清除效果不同,其中液灌流联合血液透析组及血液透析滤过组治疗埘细胞因子清除有效,血液透析组治疗对细胞因子清除基本无效,液灌流联合血液透析组及血液透析滤过组细胞因子清除效果与血液透析滤过组比较差异无统计学意义(P＞0.05).

Efficacy of clinical application of various hemodialysis modalifies of cytokines removal for uremic patients

Objectives To examine the effiency of various hemodialysis methods for uremic patients on removal of serum cytokines.Methods From April 2006 to February 2009,45 bemodialysis patients with chronic renal failure and uremia in the Hemodialysis Center,Third Affiliated HoSpital of Baotou Medical College,with pre-dialysis serum creatinine concentration ＞ 707 μmol/L,Ccr creatinine clearance ＜ 10 ml/min were randomly divided into three groups,each with 15 cases (1) hemoperfusion(HP) + hemedlalysis(HD)group,(2) bemodiafiltration(HDF) group and (3)HD group,HP+ HD group and HDF group received hemodialysis therapy once a week,three times per group with a week interval between treatments.5 ml arterial blood samples from each uremic patient and the normal control were collected respectively before and after the first and third hemodialysis and were submitted for the measurement of cytoldnes concentrations in serum.Results The concentration change of IL-1β,IL-6,serum TNF-α (tumor necrosis factor-α) between uremic patients and healthy controls was statistically significant (P＜0.01).The variation Of IL-1β and IL-6,TNF-α concentrations before and after treatment between HP+ HD group,HDF group and HD group as followed:in HDgroup TNF-α,IL-1β and IL-6 levels were ( 3±10) ng/L,(4±9) ng/L,( 4 ～ 9) ng/Land percentage change were 176.0%,141.0%,and 187.0%,respectively;in HDF group TNF-α,IL-1β and IL-6 levels were (39± 5)ng/L,(36±14)ng/L,(45±16)ng/L and percentage change were 24.6%,22.1% and 29.8%,respectively and in HP + HD group TNF-α,IL-1β and IL-6 levels were were (48±16)ng/L,(38±15)ng/L,(50±14)ng/L and percentage change were 27.8%,23.9% and 32.3%,respectively.Thus,in these three groups serum TNF-α,IL-1β and IL-6 levels were significantly changed between the treatments(t=17.39,11.24 and 21.89,respectively,P＜0.01).Conclusions This clinical study confirmed that efficacy of different treatments of hemodialysis to remove serum cytokines was various and HP + HD group and HDF group showed effective on cytokine removal while HD group didn' t.There was no significant difference between HP + HD and HDF on the serum cytokines removal in uremic patients.