高通量血液透析治疗对重症肾衰竭患者β2-MG水平及T细胞亚群的影响  

Effects of high-throughput hemodialysis onβ2-MG levels and T cell subsets in patients with severe renal failure

作　　者：高航 李小红 王莎莎 陈静 GAO Hang;LI Xiao-hong;WANG Sha-sha(Department of Critical Care Medicine,People's Hospital of Wuhan University,Wuhan Hubei 430000,China)

机构地区：[1]武汉大学人民医院重症医学科,湖北武汉430000 [2]黄冈市人民医院,湖北黄冈438000

出　　处：《临床和实验医学杂志》2022年第8期825-830,共6页Journal of Clinical and Experimental Medicine

基　　金：湖北省自然科学基金项目(编号:2019CFB261)。

摘　　要：目的 探究高通量血液透析治疗对重症肾衰竭患者β2-微球蛋白(β2-MG)水平及T细胞亚群的影响。方法 前瞻性选取2019年1月至2020年1月武汉大学人民医院收治的90例重症肾衰竭患者为研究对象,按随机数字表法分为对照组(n=45)和观察组(n=45),对照组给予基础治疗+常规血液透析,观察组给予基础治疗+高通量血液透析。比较两组临床疗效、血液毒素指标[血清尿素氮、血肌酐、血磷、β2-MG]水平、炎症因子[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)]水平、T淋巴细胞亚群[CD3^(+)、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+)]水平、不良反应发生情况及随访1年的生存情况。结果 观察组总有效率明显高于对照组(95.56%vs.80.00%),差异有统计学意义(P <0.05)。治疗后,观察组尿素氮、血肌酐、血磷、β2-MG、CRP、TNF-α、IL-6、CD8^(+)水平明显低于对照组,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平明显高于对照组,差异均有统计学意义(P <0.05)。两组不良反应总发生率比较差异无统计学意义(22.22%vs.17.78%,P> 0.05)。随访1年,观察组累积生存率为88.89%,对照组累积生存率为71.11%,经Log-rank检验进行分析比较,观察组累计存活率明显高于对照组,差异有统计学意义(P <0.05)。结论高通量血液透析用于治疗重症肾衰竭患者,可提高临床疗效,降低血液毒素和炎症因子水平,改善细胞免疫功能,安全性较好,对提升患者生存时间有积极意义。Objective To investigate the effects of high-throughput hemodialysis onβ2-microglobulin(β2-MG)levels and T cell subsets in patients with severe renal failure.Methods A total of 90 patients with severe renal failure admitted to People's Hospital of Wuhan University from January 2019 to January 2020 were prospectively randomly divided into control group(n=45)and observation group(n=45)according to the random number table method.The control group was given basic treatment plus routine hemodialysis,and the observation group was given basic treatment plus high-throughput hemodialysis.Clinical efficacy,serum toxin levels[serum urea nitrogen(BUN),serum creatinine(Scr),serum phosphorus(P),β2-MG],inflammatory factors[C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)],T lymphocyte subsets[CD3+,CD4+,CD8+and CD4+/CD8+],the occurrence of adverse reactions,and the survival situation of 1 year follow-up were compared.Results The total effective rate of observation group was significantly higher than that of control group(95.56%vs.80.00%),the difference was statistically significant(P<0.05).After treatment,the levels of BUN,Scr,P,β2-MG,CRP,TNF-α,IL-6 and CD8+in observation group were significantly lower than those in control group,while the levels of CD3+,CD4+and CD4+/CD8+were significantly higher than those in control group,the differences were statistically significant(P<0.05).There was no statistically significant difference in the total incidence of adverse reactions between the two groups(22.22%vs.17.78%,P>0.05).The cumulative survival rate of the observation group was 88.89%,while that of the control group was 71.11%.Log-rank test showed that the cumulative survival rate of the observation group was significantly higher than that of the control group,the difference was statistically significant(P<0.05).Conclusion High-throughput hemodialysis for patients with severe renal failure can improve the clinical efficacy,reduce the levels of hemotoxins and inflammatory factors,improve cellular im

关 键 词：重症肾衰竭 高通量血液透析 血液毒素 炎症反应 T细胞亚群 

分 类 号：R692.5[医药卫生—泌尿科学]