不同血液净化模式对终末期肾病患者微炎症状态、凝血功能的影响及预后分析  

Effects of different hemodialysis modes on the micro-inflammatory status,coagulation function,and prognosis of end-stage renal disease patients

作　　者：孙政敏[1] 庞家亮[2] 廖卫[1] SUN Zheng-min;PANG Jia-liang;LIAO Wei(Department of Medical Laboratory,the First People's Hospital of Xinxiang,Xinxiang 453000,Henan,China;不详)

机构地区：[1]新乡市第一人民医院医学检验科,河南新乡453000 [2]新乡市第一人民医院血液净化中心,河南新乡453000

出　　处：《广东医学》2025年第3期438-443,共6页Guangdong Medical Journal

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210889)。

摘　　要：目的探究不同血液净化模式对终末期肾病患者微炎症状态、凝血功能的影响及分析预后。方法2021年6月至2023年12月,选取166例终末期肾病患者实施前瞻性研究,分组方法为随机数字表法,分为A组(55例,实施血液透析治疗)、B组(55例,实施血液透析滤过治疗)、C组(56例,实施高流量血液透析治疗)。比较三组微炎症状态、凝血功能、不良反应与并发症、预后状况的差异。结果与治疗前相比,治疗后三组白细胞介素-6(interleukin-6,IL-6)、C反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、可溶性白细胞介素-2受体(soluble interleukin-2 receptor,sIL-2R)均降低(P<0.05);且B组、C组IL-6、CRP、sIL-2R均低于A组(P<0.05),其余组间各指标比较差异无统计学意义(P>0.05)。与治疗前相比,治疗后三组血管性血友病因子(von Willebrand factor,vWF)、活化部分凝血酶时间(activated partial thromboplastin time,APTT)、D二聚体(d-dimer,D-D)、血浆纤维蛋白酶原(fibrinogen,Fbg)均降低(P<0.05);且B组、C组vWF、APTT、D-D、Fbg均低于A组(P<0.05)。各组不良反应(皮疹、头晕头痛、胃肠道反应、皮肤瘙痒与总发生率)、并发症(低血压、心律失常、高血压、肌肉痉挛)比较差异无统计学意义(P>0.05),与A组相比,B组、C组并发症总发生率均更低(P<0.05)。对三组患者进行电话随访,随访至2024年1月,随访1~31个月,无失访者,与A组相比,B组、C组病死率均更低(P<0.05),且C组心脑血管病引发死亡低于A组(P<0.05)。Kaplan-Meier生存分析显示,B组、C组总生存情况优于A组,差异均有统计学意义(P<0.05)。结论高流量血液透析与血液透析滤过治疗终末期肾病均具有较好效果,可有效缓解微炎症状态,改善凝血功能,降低并发症发生率,且改善预后。Objective To explore the effects of different hemodialysis modes on the micro-inflammatory status,coagulation function,and prognosis of end-stage renal disease(ESRD)patients.Methods From June 2021 to December 2023,a prospective study was conducted with 166 ESRD patients.The patients were randomly assigned into three groups:Group A(55 cases,receiving hemodialysis treatment),Group B(55 cases,receiving hemodiafiltration treatment),and Group C(56 cases,receiving high-flux hemodialysis treatment).The differences in micro-inflammatory status,coagulation function,adverse reactions,complications,and prognosis among the three groups were compared.Results After treatment,the levels of interleukin-6(IL-6),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),and soluble interleukin-2 receptor(sIL-2R)decreased significantly in all three groups(P<0.05).Additionally,Group B and Group C had lower levels of IL-6,CRP,and sIL-2R than Group A(P<0.05),while other comparisons between groups showed no significant differences(P>0.05).After treatment,von Willebrand factor(vWF),activated partial thromboplastin time(APTT),d-dimer(D-D),and fibrinogen(Fbg)decreased in all three groups(P<0.05).Group B and Group C showed lower levels of vWF,APTT,D-D,and Fbg compared to Group A(P<0.05).There were no significant differences in the incidence of adverse reactions(e.g.,rash,dizziness,gastrointestinal reactions,skin itching,and total incidence)and complications(e.g.,hypotension,arrhythmia,hypertension,muscle cramps)among the three groups(P>0.05).However,the total incidence of complications in Group B and Group C was significantly lower than in Group A(P<0.05).The follow-up period lasted from 1 to 31 months(until January 2024),with no cases lost to follow-up.Group B and Group C had lower mortality rates compared to Group A(P<0.05).Furthermore,Group C had a lower cardiovascular-related mortality than Group A(P<0.05).Kaplan-Meier survival analysis indicated that the overall survival rate in Group B and Group C was better than in Group A,with statis

关 键 词：终末期肾病 不同血液净化模式 微炎症状态 凝血功能 预后 

分 类 号：R459.5[医药卫生—治疗学] R392.7[医药卫生—临床医学]