杂合型血液净化对腹膜透析不充分ESRD患者透析充分性、免疫、炎症的影响  

Effect of Hybrid Blood Purification on Dialysis Adequacy,Immunity,and Inflammation in ESRD Patients with Inadequate Peritoneal Dialysis

作　　者：关毅标 黄胜 李丽波 GUAN Yibiao;HUANG Sheng;LI Libo(Dept.of Nephrology,Nanhai District People’s Hospital,Foshan Guangdong 528200,China)

机构地区：[1]佛山市南海区人民医院肾内科,广东佛山528200

出　　处：《昆明医科大学学报》2024年第8期125-132,共8页Journal of Kunming Medical University

基　　金：佛山市医学科技攻关基金资助项目(2220001003975)。

摘　　要：目的 探究杂合型血液净化在腹膜透析不充分终末期肾病(ESRD)中的应用及对透析充分性、慢性炎症状态及安全性改善作用。方法 选取2020年9月至2022年8月佛山市南海区人民医院腹膜透析不充分ESRD患者80例,随机分为2组,每组40例,对照组采取单纯血液透析,观察组采取杂合型血液净化,连续治疗3个月。比较2组一般资料、治疗前后血清指标[全段甲状旁腺激素(iPTH)、β2-微球蛋白(β2-MG)、胱抑素C(CysC)]、肾功能指标[尿素氮(BUN)、血肌酐(Scr)、残存肾功能(RRF)]、营养状况[血红蛋白(Hb)、白蛋白(Alb)、转铁蛋白(TRF)]、慢性炎症状态[白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)]、红细胞免疫功能[红细胞免疫复合物花环率(RBC-ICR)、红细胞C3b受体(RBCC3bR)、CD35阳性红细胞百分率]及尿素清除指数(KT/V)、并发症情况。结果 治疗1、3个月后观察组iPTH、β2-MG、CysC水平均低于对照组,KT/V高于对照组(P <0.05);治疗1、3个月后观察组BUN、Scr、RRF水平均较对照组降低(P <0.05);治疗1、3个月后观察组Hb、Alb、TRF及CD35阳性红细胞百分率、RBC-C3bR水平高于对照组,IL-6、hs-CRP、TNF-α、RBC-ICR水平低于对照组(P <0.05);观察组并发症发生率7.50%与对照组20.00%相比,差异无统计学意义(P> 0.05)。结论 杂合型血液净化运用弥散、对流及吸附原理能最大限度地清除炎症介质,提高透析充分性和红细胞免疫粘附活性,改善机体营养状态和肾功能,应用于透析不充分ESRD患者效果显著。Objective To explore the application of hybrid blood purification in patients with end-stage renal disease(ESRD)with inadequate peritoneal dialysis,and its effects on dialysis adequacy,chronic inflammation status,and safety improvement.Methods 80 patients with inadequate peritoneal dialysis(ESRD)in Foshan Nanhai District People's Hospital from September 2020 to August 2022 were selected and randomly divided into two groups,with 40 cases in each group.The control group received simple hemodialysis,while the observation group received hybrid blood purification continuously for 3 months.A comparison was made between the general data of the two groups,serum indicators before and after treatment[intact parathyroid hormone(iPTH),β2-microglobulin(β2-MG),cystatin C(CysC)],renal function indicators[blood urea nitrogen(BUN),serum creatinine(Scr),residual renal function(RRF)],nutritional status[hemoglobin(Hb),albumin(Alb),transferrin(TRF)],chronic inflammatory status[interleukin-6(IL-6),high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-alpha(TNF-α)],red blood cell immune function[red blood cell immune complex ring rate(RBC-ICR),red blood cell C3b receptor(RBC-C3bR),CD35-positive red blood cell percentage]and urea clearance index(KT/V),as well as the incidence of complications.Results After 1 and 3 months of treatment,the levels of iPTH,β2-MG and CysC in the observation group were lower than those in the control group,and KT/V was higher than that in the control group(P<0.05);after 1 and 3 months of treatment,BUN,Scr,RRF levels were lower than those in the control group(P<0.05);after 1 and 3 months of treatment,the levels of Hb,Alb,and TRF in the observation group were higher than those in the control group,and the levels of IL-6,hs-CRP,and TNF-αwere lower than those in the control group(P<0.05);after 1 and 3 months of treatment,the percentage of CD35-positive red blood cells and RBC-C3bR level in the observation group were higher than those in the control group,and the RBC-ICR level was lower than that

关 键 词：杂合型血液净化 透析充分性 终末期肾病 慢性炎症 安全性 

分 类 号：R692[医药卫生—泌尿科学]