【摘要】 目的观察常规血液透析(hemodialysis,HD)、高通量血液透析(high-flux hemodialysis,HFD)、血液灌流(hemoperfusion,HP)对终末期肾病(end-stage renal disease,ESRD)维持性血液透析(maintenance hemodialysis,MHD)患者微炎症状态的影响。方法选择广西百色市人民医院透析龄超过6个月的稳定MHD患者48例,随机分为HD组16例、HFD组16例和HD+HP组16例。3组患者分别在首次治疗前后,以及治疗3个月后透析前,通过免疫比浊法和酶联免疫吸附法(ELISA)测定患者C反应蛋白(C-reactive protein,CRP)、白细胞介素6(interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)血清含量,同时测定20例健康志愿者CRP、IL-6、TNF-α血清含量作为正常对照组。结果 3组MHD患者共48例治疗前的CRP、IL-6、TNF-α水平均高于正常对照组(P<0.001),各组间差异无统计学意义(P>0.05)。HD组首次治疗后及治疗3个月后CRP、IL-6、TNF-α均升高,分别与治疗前比较差异均无统计学意义(P>0.05)。HFD组首次治疗后CRP、IL-6、TNF-α均下降,与治疗前比较差异无统计学意义(P>0.05);治疗3个月后CRP下降,与治疗前比较差异无统计学意义(P>0.05),IL-6、TNF-α下降,与治疗前比较差异有统计学意义(P<0.05)。HD+HP组首次治疗后CRP、IL-6、TNF-α均下降,其中CRP与治疗前比较差异无统计学意义(P>0.05),IL-6、TNF-α与治疗前比较差异有统计学意义(P<0.05);治疗3个月后,CRP、IL-6、TNF-α下降,与治疗前比较差异有统计学意义(P<0.05),但仍高于正常对照组。治疗3个月后,HD+HP组的CRP、IL-6、TNF-α值低于HFD组,差异有统计学意义(P<0.05),HD+HP组下降百分比高于HFD组,差异有统计学意义(P<0.01)。结论 MHD患者存在微炎症状态。HFD和HP可以降低CRP、IL-6、TNF-α水平,改善患者的微炎症状态,HP可能优于HFD。3个月治疗并不能完全纠正微炎症状态,需进一步观察更长时间或联合其他治疗方法。更多还原

【Abstract】 Objective To investigate the influence of regular hemodialysis(HD),high-flux hemodialysis(HFD) and hemoperfusion(HP) on microinflammatory state in ESRD patients on maintenance hemodialysis(MHD).Methods We enrolled 48 patients with MHD for more than 6 months in this hospital and divided them randomly into HD group(n=16),HFD group(n=16) and HD+HP group(n=16).Serum CRP,IL-6 and TNF-α were measured by immunoturbidimetry and ELISA in patients before and after the first dialysis session,and after the treatment for 3 months,as well as in 20 healthy volunteers as normal controls.Results(a) Serum CRP,IL-6 and TNF-α were significantly higher in the 3 groups of patients than in normal controls(P<0.001),but had no differences among the 3 groups of patients before the treatment(P >0.05).(b) In HD group,serum CRP,IL-6 and TNF-α increased after first dialysis session and after the treatment for 3 months,but the increases were statistically insignificantly(P>0.05).(c) In HFD group serum CRP,IL-6 and TNF-α decreased after the first dialysis session,but the decreases were statistically insignificant(P> 0.05).After the treatment for 3 months,however,serum IL-6 and TNF-α levels decreased significantly(P<0.05) without change of serum CRP level(P>0.05).(d) In HD+HP group,serum IL-6 and TNF-α decreased after the first dialysis session(P<0.05) without change of serum CRP(P >0.05).After the treatment for 3 months,serum CRP,IL-6 and TNF-α decreased(P<0.01),but were still higher than those of normal control group.(e) After the treatment for 3 months,serum CRP,IL-6 and TNF-α were significantly lower in HD+HP group than in HFD group,and the extent of the decreases was larger in HD+HP group than in HFD group.Conclusions(a) Microinflammation state exists in ESRD patients on MHD.(b) The lowering of patients’ serum CRP,IL-6 and TNF-α and thus the recovery from microinflammatory state can be achieved by HFD and HP,and preferably by HP.(c) Patients’ microinflammatory state can not radically corrected after 3 months treatment,therefore,other measures and longer period of follow-up must be conducted for these patients.更多还原