高通量血液透析治疗对维持性血透患者微炎症和营养状况的临床观察  

High flux hemodialysis treatment on micro inflammation and chronic hemodialysis patients nutrition status of clinical observation

作　　者：岳华 张俊 娜孜亚·斯加克 

机构地区：[1]维吾尔自治区人民医院肾病科,新疆830001

出　　处：《国际泌尿系统杂志》2015年第6期887-893,共7页International Journal of Urology and Nephrology

基　　金：新疆维吾尔自治区科技援疆项目课题资助（编号：201191161）

摘　　要：目的 探讨高通量血液透析对维持性血液透析患者微炎症状态和营养状况的影响.方法 选取2011年7月至2012年11月在新疆自治区人民医院血净中心长期固定的50例维持性血液透析患者,将入选患者随机分成两组,分别使用低通（CHD组）和高通（HFHD组）两种不同的透析器进行透析.以3个月为观察周期,分别测定两组患者入组后首次透析（透析前）和治疗3个月后（透析前）的血浆白蛋白（Alb）、血红蛋白（HB）、肌酐（Cr）、尿素氮（BUN）、血清C反应蛋白（CRP）、白细胞介素-6（IL-6）、β2微球蛋白（β2-MG）、甲状旁腺激素（PTH）的水平进行比较,同时进行主观综合性营养评估（subjective global as-sessment SGA）,记录入组时和治疗3个月后的体重、体重指数、肱三头肌皮肤皱褶厚度（TSF）、上臂中段周径（MAC）和上臂中段肌肉周径（MAMC）.使用游标卡尺测量TSF用软尺测量MAC再计算MAMC.结果 CHD组与HFHD组首次透前各项指标比较无统计学差异（P＞0.05）;CHD组治疗3个月后对Cr、BUN、PTH、IL-6、CRP清除无统计学差异（P＞0.05）,对Alb和Hb的影响无统计学差异（P＞0.05）;HFHD组治疗3个月后对BUN、Cr清除无差异（P＞0.05）,对PTH、IL-6、CRP、β2-MG清除有统计学差异（P＜0.05）,对Alb和Hb的提升有统计学差异（P＜0.05）;HFHD组与CHD组之间治疗3个月后对Cr、BUN清除无统计学差异（P＞0.05）,对PTH、β2-MG、IL-6、CRP清除有统计学差异（P＜0.05）,对Alb、Hb的提升有统计学差异（P＜0.05）.HFHD组治疗3个月后肱三头肌皮褶厚度、上臂中段周径测量值升高,有统计学差异（P＜0.05）,两组治疗后对体重、BMI、MAMC的测量值无统计学意义.结论 高通量透析与常规低通量透析相比对PTH、β2-MG等大中分子毒素和IL-6和CRP等微炎症细胞因子的清除能力更显著,治疗效果优于常规透析.可以更有效降低长期透析患者的微�Objectives To explore high flux hemodialysis micro inflammation in patients with maintenance hemodialysis and the effect of nutritional status.Methods The medical records and associated data of 50 patients cases at 20-80 years old in our blood purification center from May 2011 to November 2012.Patients were divided into two groups at random,rspectively with low-flux dialyzer and high-flux dialyzer.Serum indiacators on two groups for the first time dialysis and 3 months after treatment,such as：hemoglobin （Hb）,urea nitrogen （BUN）,Creatitine （C r）,parathyroid hormone （PTH）,interleukin-6 （IL-6）,serum c-reactive protein （CRP）,albumin （Alb）,β2-micro globulin（β2-MG） was analyzed by change.Record subjective global assessment （SGA）,records into groups and treatment after 3 months of body weight,body mass index （bmi）,triceps skin fold thickness （TSF）,upper arm week of middle diameter （MAC） and upper arm muscle in middle weeks size （MAMC）.Using vernier calipers measurement TSF MAC was measured with a flexible rule to calculate the MAMC.Results CHD group and HFHD group for the first time through the indicators before had no statistical difference （P 〉 0.05）;CHD group 3 months after treatment of Cr,BUN,PTH,IL-6,CRP had no statistical significance （P 〉 0.05）,the Alb and Hh had no statistical significance （P 〉 0.05）;HFHD group 3 months after treatment the BUN,Cr removal of no difference （P 〉 0.05）,the PTH,IL-6,CRP,β2-MG removal was statistically significant （P 〈0.05）,the Alb and Hb ascension was statistically significant （P 〈 0.05）;Between CHD group and HFHD group 3 months after treatment of Cr,BUN had no statistical significance （P 〉 0.05）,the PTH,β2-MG,IL-6,CRP had statistical significance（P 〈 0.05）,Hb and Alb ascend was statistically significant （P 〈 0.05）.HFHD with CHD group 3 months after treatment,triceps skinfold,upper arm middle diameter measured values rise,zhou was statistically significant （P 〈 0.05）,

关 键 词：肾透析 炎症 营养状况 

分 类 号：R459.52[医药卫生—治疗学]