高通量聚砜膜血液透析对维持性血液透析患者炎性介质及营养状况的影响

摘要

目的：观察高通量聚砜膜血液透析对维持性血液透析(MHD)患者炎性介质及营养状况的影响，并探讨其发生机制。方法：对转换为高通量聚砜膜血液透析治疗的96例常规MHD患者进行治疗前、治疗后6个月和12个月的超敏C反应蛋白(hs-CRP)、白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、白蛋白(ALB)、血红蛋白(Hb)以及β2-微球蛋白(β2-MG)检测，同时记录单室尿素清除指数(spKt/V)。结果：①高通量聚砜膜透析治疗6个月和12个月后，与治疗前比较，患者hs-CRP与β2-MG明显降低，差异有统计学意义(F=6.53，P＜0.05)，spKt/V明显增高，差异有统计学意义(F=4.35，P＜0.05)，而IL-6在治疗12个月后明显降低，与治疗前比较差异有统计学意义(F=7.21，P＜0.05)；②hs-CRP与ALB之间呈明显负相关(r=-0.463，r=-0.396， r=-0.402；P＜0.05)。提示MHD患者的炎性介质可能参与了其低蛋白血症的发生和发展，hs-CRP水平升高可能是低蛋白血症的危险因素。结论：高通量聚砜膜血液透析能够有效减轻MHD患者微炎症状态和改善其营养状况，对提高生活质量及长期生存率具有重要意义。%Objective:To observe the effect of high-flux polyethersulfone dialysis membrane to inflammatory mediators and nutritional status in patients with maintenance hemodialysis, and to explore its mechanism.Methods: Ninety six patients with low-flux maintainance hemodialysis were recruited after changing to a high-flux hemodialysis. Hs-CRP, IL-1, IL-6,ALB, Hb,β2-MG were tested before treatment, 6 months and 12 months after treatment, at the same time single chamber urea clearance index (spKt/V) was recorded. Results:①The compare results among high-flux polysulfone membrane dialysis treatment for 6 months and after 12 months, and before treatment, hs-CRP andβ2-MG significantly decreased (F=6.53,P<0.05), spKt/V was significantly higher(F=4.35, P<0.05), and IL-6 significantly decreased at 12 months after treatment, compared with before treatment, the difference was statistically significant (F=7.21,P<0.05).②There was significantly negative correlation between hs-CRP and ALB (r=-0.463,r=-0.396,r=-0.402;P<0.05). Inflammatory mediators may participate in the occurrence and development of its hypoalbuminemia in MHD patients, and elevated hs-CRP levels may be a risk factor for hypoalbuminemia. Conclusion:High-flux polysulfone membrane hemodialysis can effectively reduce micro-inflammatory state MHD patients and improve their nutritional status, improve the quality of life and long-term survival.