维持性血液透析患者微炎性反应状态与血管通路失功的相关研究

Correlation between microinflammatory response status and vascular access failure in maintenance hemodialysis patients

目的维持性血液透析患者微炎性反应状态与血管通路失功的相关研究。方法选取北京航天总医院血透中心2016年01月至2020年01月收治接受血液透析治疗的肾脏病终末期患者75例,按血液透析情况不同分为三组,首次行动静脉内瘘肾衰竭终末期患者为1组(n=25);血液透析(使用超纯透析液)未发生血管通路失功患者为2组(n=25);血液透析(使用超纯透析液)发生血管通路失功患者为3组(n=25)。观察并比较三组患者生化及炎性指标,并根据患者检测相关指标进行相关性分析。结果第3组患者血沉(ESR)、血小板(PLT)、血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和单核细胞趋化因子-1(MCP-1)均高于第1组和第2组患者;高密度脂蛋白(HDL)均低于第1组和第2组患者;总胆固醇(TC)高于第2组患者,但低于第1组患者,差异有统计学意义(P<0.05)。患者血清hs-CRP水平与ESR和HDL呈正相关(P<0.05);与PLT和TC呈负相关(P<0.05)。结论尿毒症维持性血液透析患者体内微炎性反应状态可能是血管通路失功的诱因。

Objective To explore the relationship between the state of micro inflammatory response and the dysfunction of vascular access in maintenance hemodialysis patients.Method From January 2016 to January 2020,the hemodialysis center of Beijing Aerospace General Hospital was selected to treat 75 patients with end-stage renal disease who received hemodialysis treatment.According to the different hemodialysis conditions,they were divided into three groups.The patients with end-stage renal failure after the first action of IVF were divided into one group(n=25);the patients without vascular failure during hemodialysis(using ultrapure dialysate)were divided into two groups(n=25);hemodialysis making three groups(n=25).The biochemical and inflammatory indexes of the three groups were observed and compared,and the correlation analysis was carried out according to the relevant indexes detected by the patients.Result Erythrocyte sedimentation rate(ESR),platelet(PLT),hypersensitive C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF–α),interleukin-6(IL-6)and monocyte chemotactic protein-1(MCP-1)in group 3 were higher than those in group 1 and 2,high-density lipoprotein(HDL)was lower than those in group 1 and 2,total cholesterol(TC)was higher than those in group 2,but lower than those in group 1,the difference was statistically significant(P<0.05).The serum hs-CRP level was positively correlated with ESR and HDL(P<0.05),and negatively correlated with PLT and TC(P<0.05).Conclusion The state of micro inflammatory reaction in uremic maintenance hemodialysis patients may be the inducement of dysfunction of vascular access.