不同透析方式对毒素清除及炎症反应的影响  

Effects of Different Dialysis Methods on the Removal of Toxins and Inflammatory Reaction

作　　者：韩凌[1] 郝林涛 李垟[1] 李红梅[1] 刘素[1] 邹作君[1] 

机构地区：[1]青岛大学,山东青岛266000

出　　处：《中外医学研究》2016年第13期1-4,共4页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:比较不同透析方式和膜材料对维持性血液透析(MHD)患者尿毒症毒素清除及患者炎症反应和氧化应激状态的影响。方法:选择MHD患者46例,按照随机数字表法分为四组:低通量聚砜膜组8例、低通量双醋酸纤维膜组8例、高通量聚砜膜组20例、血液透析联合血液透析滤过(HD+HDF)组10例,比较四组患者入组前和透析治疗3个月、6个月的血清肌酐(Scr)、血尿素氮(BUN)、β2-微球蛋白(β2-MG)、甲状旁腺素(i PTH)、超敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)、晚期氧化蛋白产物(AOPP)、丙二醛(MDA)水平变化。结果:低通量聚砜膜组和低通量双醋酸纤维膜组经治疗6个月后IL-6、hs-CRP、AOPP和MDA均较入组前有所上升(P<0.05),β2-MG和i PTH则均无明显变化(P>0.05)。治疗6个月后β2-MG、i PTH、IL-6、MDA和AOPP则均有所下降,与治疗3个月后和低通量聚砜膜组同期水平比较差异均有统计学意义(P<0.05),但MDA和AOPP在治疗3个月后下降均不明显(P>0.05)。HD+HDF组上述各项指标均随治疗时间增加而下降(P<0.05)。四组患者的Scr、BUN治疗前后比较,差异均无统计学意义(P>0.05)。结论:(1)高通量透析及血液透析合并血液透析滤过相对于低通量透析,可增加大中分子毒素的清除,二者均可改善患者体内炎症反应和氧化应激状态,且血液透析联合血液透析滤过治疗效果可能优于高通量透析。(2)相对于双醋酸纤维膜,聚砜膜可相对较少地引起MHD患者体内炎症反应和氧化应激状态的发生。Objective：To compare the effects of different dialysis methods and membrane materials on the clearance of uremic toxins and inflammatory reaction and oxidative stress in patients with maintenance hemodialysis.Method：46 MHD patients were randomly assigned into 4 groups：low-flux polysulfone membrane group 8 cases,low-flux diacetate fiber membrane group 20 cases,high-flux polysulfone membrane group 20 cases,hemodialysis combined with hemodiafiltration（HD＋HDF） group 10 cases.The Serum creatinine（Scr）,blood urea nitrogen（BUN）,β2-microglobulin（β2-MG）,intact PTH（i PTH）,highsensitive C reactive protein（hs-CRP）,interleukin-6（IL-6）,advanced oxidation protein products（AOPP）and malondialdehyde（MDA） level changes of the four groups were compared in groups before and dialysis treatment for 3 months,6 months.Result：After 6 months of treatment,the IL-6,hs-CRP,AOPP and MDA of the low-flux polysulfone membrane group and the low-flux diacetate fiber membrane group all increased compared with the previous levels before enter the group（P〈0.05）,β2-MG and i PTH were not significantly changed（P〉0.05）.After 6 months of treatment,the β2-MG,i PTH,IL-6,MDA and AOPP were all decreased,compared with after 3 months treatment and the low-flux polysulphone membrane group level in the same period,the differences were statistically significant（P〈0.05）,however,MDA and AOPP were not significantly decreased after 3 months（P〉0.05）.All the indexes in HD＋HDF group were decreased with the increase of treatment time（P〈0.05）.Before and after treatment,the Scr,BUN of the four groups,the differences were not statistically significant（P〉0.05）.Conclusion：（1）High-flux dialysis and hemodialysis combined with hemodiafiltration with respect to low-flux dialysis,can increase the clearance of middle molecule toxins that can be improved in patients with inflammatory reaction and oxidative stress status in and hemodialysis union blood dialysis filtration treatment effect may

关 键 词：血液透析 透析膜 尿毒症毒素 炎性因子 氧化应激 

分 类 号：R692.5[医药卫生—泌尿科学]