血液透析滤过及血液透析串联血液灌流对老年维持性血液透析患者营养状况和微炎症状态的影响  

Effects of hemodialysis filtration and hemodialysis tandem hemoperfusion on nutritional status and microinflammatory status in elderly maintenance hemodialysis patients

作　　者：叶茵[1] 宛家奎[1] 章凌云[1] 李金玉[1] 汪成军[1] YE Yin;WAN Jiakui;ZHANG Lingyun;LI Jinyu;WANG Chengjun(Department of Nephrology,Huangshan People's Hospital,Huangshan 245000,Anhui,China)

机构地区：[1]黄山市人民医院肾脏病科,安徽黄山245000

出　　处：《西部医学》2025年第2期273-277,共5页Medical Journal of West China

基　　金：2022年度校教学医院科研专项课题(JXYY202263)。

摘　　要：目的 探讨血液透析滤过(HDF)及血液透析(HD)串联血液灌流(HP)对老年维持性血液透析(MHD)患者营养状况和微炎症状态的影响。方法 选取102例在本院肾内科血液透析中心接受治疗的老年MHD患者,随机分为HDF组和HD+HP组,每组51例,HDF组给予HDF治疗,HD+HP组给予HD串联HP治疗,对比两组治疗前后的血清铁代谢指标[铁(SI)、总铁结合力(TIBC)、血清铁饱和度(ISAT)]、营养相关生化指标[白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TRF)及血红蛋白(Hb)]、微炎症指标[高敏C反应蛋白(hs-CRP)、降钙素原(PCT)及白介素-6(IL-6)]水平及血清CD14、CD64表达含量。结果 治疗后,两组血清SI、TIBC、ISAT、ALB、PA、TRF及Hb水平相比治疗前呈显著升高趋势(P<0.05),其中HD+HP组显著高于HDF组(P<0.05);治疗后,两组血清hs-CRP、PCT、IL-6、CD14及CD64水平相比治疗前呈显著降低趋势(P<0.05),其中HD+HP组显著低于HDF组(P<0.05)。结论 相较于HDF治疗,老年MHD患者采取HD串联HP治疗后能改善铁代谢水平紊乱和纠正营养不良状况,改善机体长期慢性微炎症状态,并可降低血清CD14及CD64表达,以改善患者预后。Objective To explore the influence of hemodiafiltration(HDF) and hemodialysis(HD) in series with hemoperfusion(HP) on nutritional status and microinflammatory state in elderly patients undergoing maintenance hemodialysis(MHD).Methods 102 elderly patients with MHD who received treatment in hemodialysis center of department of nephrology of our hospital were selected and randomly divided into control group and observation group with 51 cases in each group.The control group was treated with HDF,while the observation group was given HD in series with HP.Serum iron metabolism indicators [serum iron(SI),total iron binding capacity(TIBC),serum iron saturation(ISAT)],nutrition-related biochemical indicators [albumin(ALB),prealbumin(PA),transferrin(TRF) and hemoglobin(Hb)],micro-inflammatory indicators [high-sensitivity C-reactive protein(hs-CRP),procalcitonin(PCT) and interleukin-6(IL-6)] and expression levels of serum CD14 and CD64 were compared between the two groups before and after treatment.Results After treatment,the levels of serum SI,TIBC,ISAT,ALB,PA,TRF and Hb in the two groups showed significant upward trends compared with those before treatment(P<0.05),and the levels in observation group were significantly higher than those in control group(P<0.05).The levels of serum hs-CRP,PCT,IL-6,CD14 and CD64 in both groups showed significant downward trends after treatment compared to before treatment(P<0.05),and the observation group had significantly lower levels(P<0.05).Conclusion Compared with HDF treatment,HD in series with HP treatment in elderly MHD patients can better improve the iron metabolism,nutritional status and microinflammatory state,and reduce serum CD14 and CD64 to improve the prognosis of patients.

关 键 词：血液透析滤过 血液透析串联血液灌流 老年维持性血液透析患者 营养状况 微炎症状态 

分 类 号：R692.51[医药卫生—泌尿科学]