连续性血液透析滤过改善顽固性心力衰竭患者心功能的机制探讨  

Study on the improvement of cardiac function by continuous hemodiafiltration in patients with refractory heart failure

作　　者：李旭[1] 刘加明[1] 李玉琴[1] 金鑫[1] 阿丽娅[1] 

机构地区：[1]新疆石河子市人民医院肾病内科,石河子市832000

出　　处：《中国血液净化》2015年第11期662-666,共5页Chinese Journal of Blood Purification

基　　金：新疆生产建设兵团第八师石河子市科技计划项目(项目编号:2013YL09)

摘　　要：目的探讨连续性血液透析滤过改善顽固性心力衰竭患者心功能的机制。方法选择2013年3月~2015年2月收住石河子市人民医院的顽固性心力衰竭患者40例,根据患者意愿,分为连续性静-静脉血液透析滤过联合常规药物治疗组（试验组）与常规药物治疗组（对照组）各20例。记录治疗前后尿量;测量治疗48h前后体质量（BW,用于评价患者液体潴留程度）,血浆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α（TNF-α）水平,以及左心室射血分数（LVEF）,计算上述指标的改变量（ΔCRP、ΔIL-6、ΔIL-8、ΔTNF-α、ΔBW、ΔLVEF）,建立预测ΔLVEF的多元线性回归模型。结果两组治疗后48h内,试验组液体排出总量（尿量＋超滤量）超过对照组（P〈0.001）。治疗48h后,与治疗前比较,试验组CRP、IL-6、IL-8、TNF-α水平下降（P〈0.05）,对照组CRP、IL-6、IL-8、TNF-α水平略有下降,但无统计学意义（P〉0.05）,两组体质量均较治疗前下降（P〈0.05）,两组LVEF较治疗前升高（P〈0.05）;两组之间比较,试验组CRP、IL-6、IL-8、TNF-α水平低于对照组（P〈0.05）,体质量略低于对照组、LVEF略高于对照组,但均无统计学意义（P〉0.05）;试验组体质量下降值（ΔBW）、LVEF的升高值（ΔLVEF）均超过对照组（P〈0.001）。试验组ΔBW、ΔCRP、ΔIL-6、ΔIL-8与ΔLVEF呈正相关（P〈0.05）,多元线性回归模型显示,ΔBW、ΔTNF-α是ΔLVEF的独立影响因子,其中ΔBW是主要影响因子。对照组ΔBW与ΔLVEF呈正相关（P〈0.001）,ΔCRP、ΔIL-6、ΔIL-8、ΔTNF-α与ΔLVEF无相关性（P〉0.05）,只有ΔBW被纳入ΔLVEF的回归方程。结论连续性血液透析滤过改善顽固性心力衰竭患者LVEF的主要机制是减轻液体潴留、清除炎症因子,其中最重要的机制是减轻液体潴留。Objectives To investigate the improvement of cardiac function by continuous hemodiafiltra- tion in patients with refractory heart failure. Methods Forty patients with refractory heart failure treated in Shihezi People＇ s Hospital from March 2013 to February 2015 were enrolled in this study. They were assigned into continuous venous-venous hemodiafiltration （CVVHDF） combined with conventional treatment group （experiment group, n=20） or conventional treatment group （control group, n=20） based on patient＇s prefer- ence. Urinary output before and after treatment was measured. Body weight （BW）, plasma C-reactive protein （CRP）, interleukin-6 （IL-6）, interleukin-8 （IL-8） and tumor necrosis factor alpha （TNF-u）, and left ventricular ejection fraction （LVEF） were determined before treatment and after the treatment for 48 hours. Changes of these indicators （△CRP, △IL-6, △IL-8, △TNF-α, ABW, ALVEF） were then calculated. Multivariate linear re- gression model for predicting ALVEF was established. Results After the treatment for 48 hours, total fluid output （urine and ultrafiltration volume） was higher in experiment group than in control group （P〈0.001）, and the levels of CRP, IL-6, IL-8 and TNF-α decreased significantly （P〈0.05） in experiment group but not in control group （P〉0.05） as compared with those before the treatment. BW became lower and LVEF became higher in both groups （P〈0.05） as compared with those before the treatment. Levels of CRP, IL-6, IL-8 and TNF-α were lower in experiment group than in control group （P〈0.05）. BW was lower and LVEF was higher in experiment group than in control group but without statistical significance （P〉0.05）. However, the in- crease of ALVEF and decrease of ABW were more in experiment group than in control group （P〈0.001）. In experiment group, significantly positive correlations were found among ABW, ACRP, AIL-6, AIL-8, ATNF-αand △LVEF （P〈0.05）; multiple linear regression analys

关 键 词：连续性静-静脉血液透析滤过 顽固性心力衰竭 左心室射血分数 多元线性回归模型 

分 类 号：R459.5[医药卫生—治疗学]