血液透析联合血液灌流治疗维持性血液透析患者营养不良-炎症反应综合征初探

摘要

目的:针对维持性血液透析(MHD)患者营养不良-炎症反应综合征现象普遍存在而且目前为止尚无有效治疗措施的情况下,探索新的组合型治疗方式--血液透析(HD)联合血液灌流(HP)的临床疗效.方法:本院血液净化中心筛选C-反应蛋白(CRP)大于8 mg/L的MHD患者20例,先HD治疗3个月,每周透析3次,之后改为HD联合HP治疗3个月,每周透析3次,其中一次为HD联合HP,再改为HD治疗3个月.于0,3,6,9月时分别抽取患者静脉血,检测各项指标并进行营养相关的体格测量和主观综合营养评估(SGA).结果:(1)患者CRP水平在0、3、6、9月时分别为:(18.62±12.71)mg/L,(23.60±12.16)mg/L,(10.91±7.14)mg/L,(12.13±6.95)mg/L,加用HP治疗后明显下降(P<0.01),停用HP后CRP水平有所上升趋势但差异无统计学意义(P>0.05);(2)HD+HP治疗能降低Leptin、IL-8、TNF-α水平(P均<0.01),停用HP后Leptin、IL-8、TNF-α水平有所上升趋势但差异无统计学意义(P>0.05);(3)患者血清白蛋白(Alb)在0、3、6、9月时分别为(35.41±0.88)g/L,(35.49±0.96)g/L,(36.89±0.66)g/L,(36.54±0.54)g/L,差异有统计学意义(P<0.01),停用HP后Alb水平有所下降趋势但差异无统计学意义(P>0.05).结论:HD联合HP能降低维持性血透患者CRP水平及部分中分子毒素水平,提高维持性血透患者Alb水平,从而改善其营养状况.%Objective: Malnutrition - inflammatory reaction syndrome phenomenon exists generally in hemodialysis patients and so far there is no effective treatment measures, explore new combination treatments - blood dialysis combined hemoperfusion clinical curative effect. Methods: Our blood purification center the maintenance hemodialysis patients for screening C - reaction protein more than 8 mg/L in 20 patients with maintenance hemodialysis, first hemodialysis for 3 months, weekly dialysis three times, and then to hemodialysis + hemoperfusion for 3 months, weekly dialysis three times, including one for blood dialysis combined hemoperfusion, to change HD for 3 months. . Venous blood of patients were selected in 0 m, 3 m, 6 m ,9m,testing each index and nutrition related physical measurements and subjective comprehensive nutrition evaluation ( SGA ). Results:( 1 )CRP levels in patients with 0,3 , 6,9 m respectively when:( 18. 62 ± 12.71 )mg/L,( 23. 60 ± 12. 16 )mg/L,( 10. 91 ±7. 14 )mg/L,( 12. 13 ±6. 95 )mg/L,add with HP decrease after treatment P <0. 01 ), after discontinuation HP CRP level increased trend but no statistical significance ( P > 0. 05 ). ( 2 )HD + HP treatment can reduce Leptin, IL - 8, TNF alpha level( P <0. 01 ), after discontinuation HP Leptin, IL - 8, TNF alpha level increased trend but no statistical significance( P > 0. 05 ) . ( 3 )Patients serum albumin ( Alb ) at 0 m, 3 m, 6m,9m, when were ( 35.41 ±0. 88 )g/L,( 35.49 ±0.96 )g/L,( 36. 89 ±0. 66 )g/L,( 36. 54 ±0. 54 )g/L,there is significant difference( P <0.01 ), After discontinuation HP Alb level declined trend but no statistical significance( P >0. 05 ). (4 )Combined hemoperfusion after can improve nutritional status of the patients. Conclusion: HD combined HP can reduce the maintenance hemodialysis patients CRP level and part molecule toxins level so as to improve the maintenance hemodialysis patients Alb level, improve the nutritional status. Joint HP to improve the nutritional status of important reason to may and inflammatory medium and molecular toxin removal relevant.