不同血液净化方式对维持性血液透析患者微炎症状态、血脂及颈动脉内-中膜厚度的影响  

Influence of different blood purification methods on the microinflammatory state,serum lipid and carotid intima-media thickness in maintenance hemodialysis patients

作　　者：王丰平 陈民[2] 宋晓英[1] 张程珑 贺静[1] Wang Fengping;Chen Min;Song Xiaoying;Zhang Chenglong;He Jing(Department of Nephrology,Chengdu Second People’s Hospital,Sichuan Chengdu 610021,China;Department of Nephrology,Chengdu First People’s Hospital,Sichuan Chengdu 610041,China)

机构地区：[1]成都市第二人民医院肾病内科,四川成都610021 [2]成都市第一人民医院肾病内科,四川成都610041

出　　处：《中国医刊》2022年第2期167-170,共4页Chinese Journal of Medicine

基　　金：成都市卫生局青年基金课题(201122)。

摘　　要：目的探讨不同血液净化方式对维持性血液透析患者微炎症状态、血脂及颈动脉内-中膜厚度(carotid intima-media thickness,CIMT)的影响。方法选取2011年3月至2012年3月在成都市第一人民医院进行维持性血液透析的97例患者为研究对象,采用随机数字表法分为血液透析(hemodialysis,HD)组(34例)、HD+血液透析滤过(hemodialysis filtration,HDF)组(32例)、HD+血液灌流(hemoperfusion,HP)组(31例)。比较分析三组患者治疗前和治疗6个月后的C反应蛋白(C-reactive protein,CRP)、白介素-6(interleukin,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、总胆固醇(total cholesterol,TC)、甘油三酯(triacylglycerol,TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)水平以及CIMT。结果治疗6个月后,HD组患者的CRP、IL-6水平均显著高于治疗前(P<0.05),HD+HP组、HD+HDF组患者的CRP、IL-6和TNF-α水平均显著低于治疗前(P<0.05);HD+HP组、HD+HDF组患者的CRP、IL-6和TNF-α水平均显著低于HD组(P<0.05)。治疗6个月后,HD+HP组、HD+HDF组患者的TG水平均显著低于治疗前(P<0.05),而TC、LDL-C的水平与治疗前比较差异均无显著性(P>0.05);HD+HDF组、HD+HP组患者的TG水平均显著低于HD组(P<0.05),且HD+HP组患者的TG水平均显著低于HD+HDF组(P<0.05)。治疗6个月后,HD组、HD+HDF组患者的CIMT均显著大于治疗前(P<0.05);HD+HP组患者的CIMT显著小于HD组(P<0.05)。结论HD+HDF与HD+HP均能较高效地清除炎症因子,改善维持性血液透析患者的微炎症状态,且HD+HP可有效地降低患者的TG水平,减小患者的CIMT,对减轻动脉粥样硬化的形成具有积极作用,值得临床应用。Objective To investigate the influence of three different blood purification methods on the microinflammatory state,serum lipid and carotid intima-media thickness(CIMT)in maintenance hemodialysis patients.Method A total of 97 patients undergoing maintenance hemodialysis in Chengdu First People’s Hospital from March 2011 to March 2012 were selected as the research subjects.Using the random number table method,they were divided into hemodialysis(HD)group(34 cases)and HD+hemodifiltration(HPF)group(32 cases)and HD+hemoperfusion(HP)group(31 cases).The levels of C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),total cholesterol(TC),triacylglycerol(TG),low density lipoprotein cholesterol(LDL-C)and CIMT before and after 6 months of treatment in three groups were compared and analyzed.Result After 6 months of treatment,the levels of CRP and IL-6 in HD group were significantly higher than before(P<0.05);the levels of CRP,IL-6 and TNF-αin HD+HP group and HD+HDF group were significantly lower than before treatment(P<0.05).And the levels of CRP,IL-6 and TNF-αin HD+HP group and HD+HDF group were significantly lower than those in HD group(P<0.05).After 6 months of treatment,TG levels in HD+HP group and HD+HDF group were significantly lower than before(P<0.05),while there were no significant differences in TC and LDL-C levels compared with before(P>0.05).The TG in HD+HDF group and HD+HP group was significantly lower than that in HD group(P<0.05),and the TG level in HD+HP group was significantly lower than that in HD+HDF group(P<0.05).After 6 months of treatment,CIMT in HD group and HD+HDF group was significantly higher than before(P<0.05).CIMT in HD+HP group was significantly lower than that in HD group(P<0.05).Conclusion HD+HDF and HD+HP can effectively remove inflammatory factors and improve the microinflammatory state of maintenance hemodialysis patients,and HD+HP can effectively reduce the level of TG and the thickness of CIMT in patients,which has a positive effect on reducing the formation o

关 键 词：血液透析 血液透析滤过 血液灌流 微炎症状态 血脂 颈动脉内-中膜厚度 

分 类 号：R459.5[医药卫生—治疗学]