不同血液净化方式对晚期糖基化终末产物、同型半胱氨酸及炎性因子的影响

目的观察低通量血液透析(LFHD)、高通量血液透析(HFHD)和血液透析滤过(HDF)对维持性血液透析(MHD)患者晚期糖基化终末产物(AGEs)、同型半胱氨酸(Hcy)及炎性因子的影响。方法选取MHD患者54例,随机分为LFHD组、HFHD组和HDF组各18例,检测治疗前后AGEs、Hcy、CRP、IL-6及TNF-α水平的变化,另纳入30例健康体检者作为健康对照组,进行分析比较。结果与健康对照组比较,3组MHD患者透析前AGEs、Hcy、CRP、IL-6及TNF-α水平均升高(P<0.01)。与治疗前比较,LFHD组单次和透析8个月后均不能降低AGEs、Hcy、CRP、IL-6、TNF-α(P>0.05);HFHD组单次透析后AGEs、Hcy下降(P<0.05)。透析8个月后,Hcy、CRP、IL-6及TNF-α下降(P<0.05);HDF组单次和透析8个月后AGEs、Hcy、CRP、IL-6、TNF-o下降(P<0.05),透析8个月后,与LFHD组比较,HFHD组及HDF组各项指标均显著降低(P<0.05),且HDF组低于HFHD组(P<0.05)。结论 MHD患者存在微炎性状态,HDF和HFHD可以降低AGEs及Hcy水平,改善微炎性状态,HDF可能优于HFHD。

The effects of different blood purification methods on the serum AGEs,Hcy and inflammatory cytokine in maintenance hemodialysis patients

Objective To study the effect of low-flux hemodialysis （ LFHD）, high-flux hemodialysis （HFHD） and hemodiafiltration （HDF） on the serum AGEs, Hcy and inflammatory eytokine in hemodialysis （MHD） patients. Methods Fifty-four MHD patients were randomly divided into LFHD group, HFHD group and HDF group. Serum AGEs, Hey, CRP, IL-6 and TNF-α were detected,30 healthy people as the normal control group. Results Serum AGEs, Hey, CRP, IL-6 and TNF-α in patient of MHD group before statin treatment were much higher than those in normal control group. In LFHD group, serum AGEs, Hey, CRP, IL-6 and TNF-c~ were not decreased significantly after first dialysis therapy and after the treatment for 8 months（ P 〉 0.05 ）. In HFHD group, serum AGEs, Hey were decreased significantly after first dialysis therapy. After dialysis for 8 months, serum Hcy, CRP, IL-6 and TNF-α were decreased significantly （ P 〈 0.05 ）. In HDF group, serum AGEs, Hey, CRP, IL-6 and TNF-α were decreased significantly after first dialysis therapy and after the treatment for 8 months （ P 〈 0.05 ）. After dialysis for 8 months, compared with LFHD group, HFHD group and HDF group indicators are significantly reduced（ P 〈 0.05 ）, and lower in HDF group than in HFHD group（ P 〈 0.05 ）. Conclusion The MHD patients were in the micro inflammatory state. The lowering of patients＇ serum AGEs, Hcy and thus the recovery from micro inflammatory state can be achieved by using HDF and HFHD, and preferably by HDF.