血管舒张功能评价长期血液灌流串联血液透析对患者血管内皮功能的价值  

Effect of FMD evaluating long-term hemoperfusion combined with hemodialysis on vascular endothelial function

作　　者：郑峰[1] 姜燕[1] 江蕾[1] 洪海娟[1] 臧秀娟[1] 

机构地区：[1]上海市松江区中心医院肾内科,201600

出　　处：《安徽医学》2017年第4期411-414,共4页Anhui Medical Journal

基　　金：上海市松江区科学技术攻关项目(项目编号:15SJGG37)

摘　　要：目的探讨血流介导的血管舒张功能(FMD)对长期血液灌流串联血液透析患者血管内皮功能的评价作用。方法以2013年3月至2016年1月上海市松江区中心医院诊治的73例维持性血液透析患者为研究对象,其中单纯血液透析(HD)33例(HD组),血液灌流串联血液透析(HP+HD)治疗40例(HP+HD组),选择同期健康体检40例正常人群为对照组,比较各组肱动脉FMD、硝酸甘油介导的血管舒张功能(NMD)及微炎症相关指标。结果与对照组比较,HD组、HP+HD组透析前肱动脉FMD均低,血清hs-CRP、TNF-α水平均升高,差异均有统计学意义(P<0.05)。与透析前比较,HD组透析后肱动脉FMD下降[(7.10±1.52)%vs(4.75±1.65)%](P<0.05),而HP+HD组则上升[(7.08±1.60)%vs(8.40±1.53)%];HP+HD组透析后肱动脉FMD大于HD组,血清hs-CRP、TNF-α水平均低于HD组,差异均有统计学意义(P<0.05)。3组肱动脉NMD比较差异无统计学意义(P>0.05)。结论长期血液透析患者多存在血管内皮功能异常,单纯血液透析加重患者血管内皮功能损害,而血液灌流串联血液透析能有效改善机体微炎症状态及减轻血管内皮功能损害。Objective To investigate the effect of flow mediated dilation （FMD） in evaluating the vascular endothelial function in patients with long - term hemoperfusion combined with hemodialysis. Methods Seventy - three patients undergoing maintenance hemodialy-sis between March 2013 and January 2016 wereselected as the study subjects. Among them, 33 cases treated with simple hemodialysis （HD） were included in HD group,40 cases treated with hemoperfusion combined with hemodialysis （ HP ＋ HD） were included in HP ＋ HD group, and 40 healthy people undergoing physical examination in the same period were included in the control group. Brachial artery FMD, nitro-glycerin mediated dilation （NMD） and micro - inflammation related indexes were compared between groups. Results Compared with the control group, brachial artery FMD of HD group and HP ＋ HD group was significantly lower while serum hs - CRP and TNF - α levels were significantly higher （ P 〈 0. 05 ）. Compared with those before dialysis, the brachial arteryFMD was significantly decreased in HDgroup after di-alysis [ （7. 10 ± 1. 52）% vs （4. 75 ± 1. 65）% ] while in HP ＋ HD group, it was significantly increased[ （7. 08 ± 1. 60）% vs （8. 40 ± 1. 53 ） % ] ; after dialysis, brachial artery FMD of HP ＋ HD group was significantly greater than that of HD group while serum hs - CRP and TNF - α levels were significantly lower （P 〈 0. 05 ） . There was no significant difference in brachial artery NMD between the three groups （P 〉 0. 05 ）. Conclusion Most patients undergoing long - term hemodialysis have vascular endothelial dysfunction. Pure hemodialysis will increase the damage to vascular endothelial function while hemoperfusion combined with hemodialysis can effectively reduce damage in micro -inflammation and vascular endothelial function.

关 键 词：血液灌流 血液透析 血流介导的血管舒张功能 血管内皮功能 

分 类 号：R692.5[医药卫生—泌尿科学]