还原型谷胱甘肽联用血液透析滤过对维持性血液透析患者微炎症状态的影响

目的 观察还原型谷胱甘肽联用血液透析滤过（HDF）对维持性血液透析（MHD）患者微炎症状态的影响,探讨改善维持性血液透析患者微炎症状态的方法.方法 将48例维持性血液透析患者随机分为血液透析（HD）组、HDF组、HD＋还原型谷胱甘肽组、HDF＋还原型谷胱甘肽组,每组12例患者.各组患者均每周行HD、HDF各3次,并予控制血压、血脂,改善贫血及调整钙磷代谢紊乱等常规非透析疗法,同时在上述治疗基础上于透析结束后静脉注射还原型谷胱甘肽（CSH）1200毫克/次,3次/周,疗程为8周.治疗8周后检测血中超敏C-反应蛋白（Hs-CRP）、白细胞介素（IL）-6、肿瘤坏死因子-α（TNF-α）、晚期氧化蛋白产物（AOPP）的变化并进行分析.结果 HD组和HDF组患者治疗前血浆Hs-CRP、IL-6、IL-8、TNF-α和AOPP等比较差异无显著性（P〉0.05）,与对照组比较有显著性差异（P〈0.05）,说明尿毒症患者存在明显的微炎症状态;治疗2个月后可见HDF组患者血浆Hs-CRP、IL-6、IL-8、TNF-α、AOPP与治疗前比较下降明显（P〈0.05）,HD组与治疗前比较无明显下降（P〉0.05）,说明HDF对维持性血液透析患者微炎症状态有明显改善作用;HD＋还原性谷胱甘肽组与治疗前比较,HDF＋还原性谷胱甘肽组与治疗前比较血浆Hs-CRP、IL-6、IL-8、TNF-α、AOPP,均明显下降（P〈0.05）.结论 使用还原型谷胱甘肽与HDF均能够有效改善维持性血液透析患者的微炎症状态,还原型谷胱甘肽联用HDF效果更佳.

Effect of reduced glutathione and hemodiafiltration on microinflammatory state in patients with maintenance hemodialysis

Objective To observe the effect of reduced glutathione and hemodiafiltration（HDF） on microinflammatory state in patients with maintenance hemodialysis （ MHD ）, investigate the method of improvement on microinflammatory state in MHD patients. Methods Forty-eight MHD patients were randomly divided into HD group, HDF group and HD ＋ reduced glutathione group. Twelve healthy subjects from out-patient clinic for physical examination served as control. Patients in each group were treated with HD or HDF 3 times a week ; and received other conventional non-dialysis treatment, such as control blood pressure, blood lipids, improve anemia and adjust calcium and phosphorus level. Meanwhile, They were given injection of reduced Glutathione（GSH） 1200 mg ,3 times a week ,for 8 weeks. The levels of high-sensitivity C -reactive protein （ hs -CRP）, interleukin 6 （ IL-6 ）, tumor necrosis factor-α （ TNF-α）, advanced oxidation protein products（AOPP） were measured after treaments. Results The levels of hs-CRP, IL-6, TNF- α,AOPP in HD group and HDF group were higher than the control group. It is proved that patients with uremia were in microinflammatory state. After treatment, the levels of inflammatory factors of the HDF ＋ reduced glutathione group were all lower than those before treatment. Conclusion Either reduced glutathione or HDF improves micro-inflammatory state in MHD patients, hut their＇combination achieves better therapeutic effect.