枸橼酸钠抗凝血液透析患者血清白细胞介素-6、肿瘤坏死因子-α及血脂的变化

摘要

Objective To investigate the changes of the serum interlukin-6( IL-6 ), tumor necrosis factor-α ( TNF-α), lipoprotein( a )[LP( a )]and lipid in citrate anticoagulation for hemodialysis patients and analyze the correlation.Methods Ninety maintenance hemodialysis( MHD )patients were divided randomly into three groups,group A( n = 30 )were treated with citrate,group B( n = 30 ) with heparin and group C( n = 30 )with low molecular heparin. The serum IL-6,TNF-α,LP( a )were compared before and after hemodialysis in the three groups. The levels of total cholesterol( TC ),triglyceride( TG ), high density lipoprotein( HDL-c ), low density lipoprotein( LDL-c ), very low density lipoprotein ( vLDL-c )were compared before hemodialysis ,3 months, 12 months and 18 months after hemodialysis. The correlations of IL-6 ,TNF-α, LP( a )and lipid in the patients who dialyzed with citrate were analyzed. Results After hemodialysis,the level of IL-6 decreased significantly in the group A( P ＜0.05 ). After 12 months,the level of TG decreased significantly in the group A( P＜0. 05 ). Compared with group B and C, the levels of TG, LDL-c, VLDL-c decreased while HDL-c increased significantly in the group A( P ＜0.05 ). The levels of IL-6 was positively correlated with the levels of TG,LDL-c and VLDL-c( r =0. 553,0. 521,0. 512 ;P = 0. 026,0. 038,0. 043 ). Conclusion The influences of TG, LDL-c, VLDL-c and HDL-c in MHD who are dialyzed with citrate are less than those with haperin, it is probable related to the better biocompatibility.%目的 探讨应用枸橼酸钠抗凝血液透析患者血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、脂蛋白(a)[LP(a)]与血脂的变化及相关性.方法 90例维持性血液透析患者随机分为3组:枸橼酸钠抗凝组(A组)、普通肝素抗凝组(B组)、低分子肝素抗凝组(C组)各30例.分析3组透析前、后血清IL-6、TNF-α、LP(a)的变化;3组透析前、透析3个月、12个月及18个月后血清总胆固醇(TC)、三酰甘油 (TG)、高密度脂蛋白胆固醇(HDL-c)、低密度脂蛋白胆固醇(LDL-c)、极低密度脂蛋白胆固醇(vLDL-c)的变化;分析A组IL-6、TNF-α、LP(a)与血脂的相关性.结果 透析后A组IL-6下降,与透析前比较差异有统计学意义(P＜0.05).透析12个月后A组TG较透析前下降,差异有统计学意义(P＜0.05),TG、LDL-c、vLDL-c低于B、C组,HDL-c高于B、C组,差异有统计学意义(P＜0.05).IL-6与TG、LDL-c、vLDL-c呈正相关(r值分别为0.553、0.521、0.512,P值分别为0.026、0.038、0.043).结论 枸橼酸钠抗凝血液透析对维持性血液透析患者血清TG、LDL-c、vLDL-c、HDL-c的影响小于肝素,可能与其较好的生物相容性有关.