高通量透析对尿毒症维持性血液透析患者血管内皮功能的影响  

The effect of High - flux hemodialysis on vascular endothelial function in uremic pa- tients with hemodialysis

作　　者：张运刚[1] 常明[1] 刘红[1] 刘书馨[1] 刘佳[1] 

机构地区：[1]大连市中心医院肾内科,辽宁116033

出　　处：《国际泌尿系统杂志》2012年第5期611-613,共3页International Journal of Urology and Nephrology

摘　　要：目的探讨高通量血液透析（hi-gh—fluxhemodialysis，HFHD）对尿毒症维持性血液透析患者血管内皮功能的影响。方法采用自身对照研究，选取33例维持性常规低通量血液透析的尿毒症患者，接受HFHD治疗6个月。治疗前（O个月）及治疗6个月分别采血测定血脂、白介素-6（IL-6）、超敏C反应蛋白（hsCRP）、糖基化终末产物（AGEs）和p2-微球蛋白（B2-MG）水平，同时采用高分辨血管外超声检测肱动脉血流介导的内皮依赖性血管舒张功能（flow—mediateddilationFMD）。分析比较HFHD对上述指标的影响及其相关性。结果HFHD治疗后，患者高密度脂蛋白升高、胆固醇及低密度脂蛋白水平下降，IL-6、p2-MG、AGEs水平降低，均具有统计学差异；FMD较治疗前有上升趋势（6．61％±4．93％，6．85％±4．4％），但无统计学意义；相关性分析显示FMD与高密度脂蛋白呈正相关，与B2-MG呈负相关（r值分别为0．323和-0．328，P〈0．05）。结论HFHD可改善尿毒症维持性血液透析患者脂质代谢，升高高密度脂蛋白，降低胆固醇和低密度脂蛋白；同时增加炎症介质，糖基化终末产物及B2-微球蛋白的清除；HFHD能够延缓血液透析患者血管内皮功能损伤，可能与有效清除炎症介质，降低氧化应激和改善脂质代谢相关。Objectives To investigate the influence of high - flux hemodialysis （HFHD） on vascular endothelial function in hemodialysis patients. Methods Self - control study, 33 cases with maintenance of conventional low- flux hemodialysis were selected, accepted HFHD 6 months of treatment, blood samples were collected before treatment （0 month） and 6 months of treatment to determine lipids, interleukin -6 （IL- 6）, high sensitivity C- reactive protein （hsCRP）, advanced glycation end products （AGEs） and β2 - microglobulin （beta2 -MG） levels, while brachial artery flow - mediated endothelium - dependent （FMD） vasodilation were detected with high - resolution ultrasound. Further the index of FMD and the clinical detection of indicators were analyzed. Results After 6 months of treatment, high - density lipoprotein were increased, levels of cholesterol and LDL , IL - 6, β2 - MG, ang AGEs were significantly decreased; the level of FMD than before treatment, there is an upward trend （6. 61% ＋4.93% ,6.85% ＋4.4% ） ,but not statistically significant; Person analysis showed that FMD positive correlated with high - density lipoprotein and negative with β2 - MG （ r = 0. 323 and - 0. 328, P 〈 O. 05 ）. Conclusions HFHD can improve uremic hemodialysis patients with lipid metabolism, increased high - density lipoproteiu, lower cholesterol and low density lipoprotein ; increase in inflammatory mediators, advanced glyeation end products and 132 - microglobulin clearance ; HFHD slow hemodialysis patients with vascular endothelial dysfunction may be associated with the effective removal of irlflammatory mediators, reduces oxidative stress and improve lipid metabolism.

关 键 词：尿毒症 血液透析 

分 类 号：R692.5[医药卫生—泌尿科学]