血液透析联合灌流对尿毒症患者同型半胱氨酸和颈动脉内膜的影响  

The effect of hemoperfusion combined with hemodialysis on serum homocysteine and carotid intima in Uremia patients

作　　者：谭永顺[1] 王敏[2] 倪晓娜[1] 王明波[1] 王秀[1] 

机构地区：[1]山东莱芜市人民医院肾病风湿科,271100 [2]山东莱芜市人民医院检验科,271100

出　　处：《中国临床保健杂志》2016年第1期66-69,共4页Chinese Journal of Clinical Healthcare

摘　　要：目的探讨血液透析联合血液灌流对尿毒症透析患者同型半胱氨酸(Hcy)和颈动脉内膜的影响。方法选取行维持性血液透析(MHD)的尿毒症患者70例,采用简单随机化分组法分为单纯透析(HD)组、血液透析+血液灌流(HD+HP)组,各35例。监测治疗前后两组Hcy及颈动脉内膜中层厚度(IMT)及粥样硬化斑块面积。结果 (1)两组MHD患者透析前血清Hcy、C反应蛋白(CRP)、白细胞介素6(IL-6)及肿瘤坏死因子(TNF-α)水平均高于健康对照组,差异有统计学意义(t=10.34、11.12、12.32、10.65,P均<0.01);(2)治疗8个月后,HD组血清Hcy、CRP、IL-6、TNF-α水平变化差异无统计学意义(t=0.231、0.325、0.267、0.327,P均>0.05);HD+HP组血清Hcy、CRP、IL-6、TNF-α水平均显著下降,差异有统计学意义(t=9.21、10.05、9.43、10.45,P均<0.05)。HD+HP组治疗8个月后与同期HD组比较差异有统计学意义(t=8.23、10.15、8.99、9.96,P均<0.05)。(3)治疗8个月后,HD组动脉粥样斑块面积显著增加,差异有统计学意义(P均<0.05);HD+HP组颈动脉IMT和动脉粥样斑块面积差异无统计学意义(P均>0.05);(4)Hcy与颈动脉IMT以及粥样硬化斑块面积呈正相关(r=0.687,P<0.05;r=0.615,P<0.05)。结论 MHD患者存在微炎状态,常规HD不能清除Hcy,而HD+HP能够降低Hcy,改善微炎状态,并延缓颈动脉粥样硬化的过程。Objective To investigate the effect of hemoperfusion combined with hemodialysis on serum homocysteine（Hcy） and carotid intima in Uremia patients. Methods 70 Uremia patients were divided into hemodialysis group （HD） and hemoperfusion combined with hemodialysis group （HD ＋ HP）. The Hcy, carotid artery intimamedia thickness （IMT） and atherosclerotic plaque area were deceted in all the groups before-after treatment. Results 1 ） The serum Hcy, CRP, IL-6, TNF-α levels were significantly higher than those in control group with statistical significance （t = 10.34,11.12,12.32,10.65, all P 〈 0. 01 ）. 2） No differences were showed in serum Hcy, CRP, IL-6, TNF-α levels in HD group after eight-month treatment （t = 0. 231,0.325,0.267,0.327, all P values 〉 0.05 ）, while these levels were significantly decreased in HD ＋ HP group （ t = 9.21,10.05,9.43,10.45, all P 〈 0. 05 ）. Furthermore, the serum Hcy, CRP,IL-6,TNF-α levels between HD ＋ HP group and HI） group after eight-month treatment were significantly different （ t = 8.23,10.15,8.99,9.96, all P 〈 0.05 ）. 3 ） Atherosclerotic plaque area was significantly increased in HD group after eight-month treatment （P 〈 0. 05）, while no difference of carotid artery IMT was showed in HD group. No differences of carotid artery IMT and plaque area were showed in HD ＋ HP group （ P 〉 0.05）. g） Serum Hcy levels were positively correlated with carotid IMT （ r = 0.687, P 〈 0. 05 ） and atherosclerotic plaque area （ r = 0. 615, P 〈 0.05 ）, respectively. Conclusions The MHD patients are accompanied by micro-inflammatory. Serum Hcy can＇t be cleared by conventional HD treatment, while the HD ＋ HP treatment could reduce the serum Hcy levels, ameliorative micro-inflammatory and slow down the process of carotid atherosclerosis.

关 键 词：尿毒症 肾透析 灌流 半胱氨酸 颈动脉内膜中膜厚度 

分 类 号：R692.5[医药卫生—泌尿科学]