不同血液净化方式对维持性血液透析患者微炎症状况及生存质量的影响

摘要

Objective:To investigate effect of different blood purification methods on micro-inflammatory state and the quality of life in maintenance hemodialysis patients.Method:A total of 75 MHD patients in the blood purification division of the dongguan people’s hospital were randomly divided into three groups:low flux hemodialysis group(HD group,n=25),hemodiafiltration group(HDF group,n=25)and hemodialysis combined hemoperfusion group(HD+HP group,n=25).The treatments lasted 6 months.The serum C-reactive protein(CRP),interleukin-6 (IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α),hemoglobin(Hb)and serum albumin (ALB)were determined before and after the treatments in the there groups.The quality of life was evaluated using SF-36 questionaire.Result:After treatment,compared with HD groups,HDF group and HD+HP group had significantly lower levels of CRP,IL-6,IL-8,TNF-a,Ab and Hb were significantly better than before treatment(P<0.05),there were no difference between HDF group and HD+HP group.Total health condition,bodily pain,role-physical,social functioning,vitality and mental health in HDF group and HD+HP group were superior to those in HD group(P<0.05), there were no difference between HDF group and HD+HP group.But the difference was insignificant in role-emotional between three groups(P>0.05).Conclusion:Microinflammation state exists in MHD patients .HDF and HD+HP could had better effect than the HD on clearance of micro-inflammatory factor,may significantly improve the quality of life of MHD patients.%目的：研究不同血液净化方式对维持性血液透析患者微炎症状况及生存质量的影响。方法：选取东莞市人民医院血液净化室维持性血液透析患者75例，将患者随机分为三组：低通量血液透析（HD）组、血液透析滤过（HDF）组和血液透析联合血液灌流（HD+HP）组，连续治疗6个月后，检测治疗前后C反应蛋白（CRP）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、肿瘤坏死因子（TNF-α）及白蛋白（Ab）与血红蛋白（Hb）的含量，治疗前后进行两次SF-36问卷调查评估生存质量。结果：HDF组与HD+HP组治疗后CRP、IL-6、IL-8、TNF-α的清除及Ab与Hb上升均优于HD组（P<0.05），HDF组与HD+HP组两组间比较差异无统计学意义。治疗6个月前后三组患者行生存质量评分，在总体健康、躯体疼痛、躯体角色功能、社会功能、精力、心理健康方面，HDF组与HD+HP组治疗均优于HD组（P<0.05），HDF组与HD+HP组两组间比较差异无统计学意义，而情绪角色功能在治疗前后三组之间差异无统计学意义（P>0.05）。结论：维持血液透析患者存在微炎症状态，HD+HP及HDF能更好清除炎症因子，改善维持性血液透析患者微炎症状态，改善患者生存质量。