高通量与低通量血液透析治疗慢性肾功能衰竭尿毒症患者肾功能和炎性因子及AngⅡ的变化

Renal function,inflammatory factors and changes of AngⅡof patients with uremia of chronic renal failure treated with high-flux or low-flux hemodialysis

目的探讨高通量与低通量血液透析治疗慢性肾功能衰竭尿毒症患者血肌酐(SCr)、尿素氮(BUN)、β2微球蛋白(β2-MG)、尿素清除指数(KT/V)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、血管紧张素Ⅱ(AngⅡ)、内皮素-1(ET-1)和一氧化氮(NO)水平的变化。方法回顾性分析崇州市中医医院2019年7月-2021年7月收治的92例慢性肾功能衰竭尿毒症患者,根据透析治疗方式不同将其分为低通量透析组(n=42)、高通量透析组(n=50)。低通量透析组采取低通量血液透析治疗,高通量透析组采取高通量血液透析治疗。比较两组SCr、BUN、β2-MG、KT/V、TNF-α、hs-CRP、IL-6、AngⅡ、ET-1和NO水平。结果治疗前两组SCr、BUN、β2-MG和KT/V水平比较差异均无统计学意义(P均>0.05)。治疗后两组SCr和KT/V水平较治疗前上升,BUN和β2-MG水平较治疗前下降,差异均有统计学意义(P均<0.05);且高通量透析组β2-MG[(18.40±4.50)mg/L vs.(20.30±4.16)mg/L]水平低于低通量透析组,KT/V[(1.30±0.20)vs.(1.19±0.19)]水平高于低通量透析组,差异均有统计学意义(t=2.102、2.688,P均<0.05)。治疗后两组hs-CRP、IL-6和TNF-α水平均明显低于治疗前(P均<0.05),且高通量透析组hs-CRP[(4.62±2.20)mg/L vs.(13.80±3.70)mg/L]、IL-6[(3.84±3.24)μg/L vs.(7.72±5.08)μg/L]和TNF-α[(4.30±3.16)ng/L vs.(14.40±9.50)ng/L]水平明显低于低通量透析组,差异均有统计学意义(t=14.725、4.435、7.073,P均<0.05)。低通量透析组总有效率为66.67%,明显低于高通量透析组总有效率92.00%,差异有统计学意义(χ^(2)=9.309,P<0.05)。两组治疗前AngⅡ、ET-1和NO水平比较差异均无统计学意义(P均>0.05);治疗后高通量透析组AngⅡ和ET-1水平低于治疗前(P均<0.05);且高通量透析组AngⅡ和ET-1水平明显低于低通量透析组,差异均有统计学意义(t=6.767、15.371,P均<0.05)。结论高通量透析可显著提高β2-MG、AngⅡ和ET-1清除率,降低机体微炎症状态,对预后改善有重要意义。

Objective To explore the renal function,inflammatory factors and changes of erumcreatinine(SCr),urea nitrogen(BUN),β2 microglobulin(β2-MG),urea clearance index(KT/V),tumor necrosis factor-α(TNF-α),hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6),angiotensin Ⅱ(AngⅡ),endothelin-1(ET-1),nitricoxide(NO)levels with high-flux or low-flux hemodialysis.Methods Retrospective analysis was made on 92 uremic patients with chronic renal failure admitted in the Chongzhou Traditional Chinese Medicine Hospital from July 2019 to July 2021.They were divided into low flux dialysis group(n=42)and high flux dialysis group(n=50)according to the different dialysis treatment methods.The low flux dialysis group was treated with low flux hemodialysis,and the high flux dialysis group was treated with high flux hemodialysis.Compare the two groups of patients with SCr,BUN,β2-MG,KT/V,TNF-α,hs-CRP,IL-6,AngⅡ,ET-1 and NO levels.Results There was no significant difference in SCr,BUN,β2-MG and KT/V levels between the two pre-treatment groups(P>0.05).SCr and KT/V levels increased compared with the treatment,and BUN and β2-MG levels decreased after the treatment were statistically significant(P<0.05);β2-MG[(18.40±4.50)mg/L vs.(20.30±4.16)mg/L]level of high-throughput dialysis group was lower than the low-throughput dialysis group,and KT/V[(1.30±0.20)vs.(1.19±0.19)]levels of high-throughput dialysis group were higher than the low-throughput dialysis group(t=2.102,2.688,all P<0.05).After treatment,hs-CRP,IL-6,and TNF-α were significantly lower than before treatment(all P<0.05),and levels of hs-CRP[(4.62±2.20)mg/L vs.(13.80±3.70)mg/L],IL-6[(3.84±3.24)μg/L vs.(7.72±5.08)μg/L],and TNF-α[(4.30±3.16)ng/L vs.(14.40±9.50)ng/L]of high-throughput dialysis group were significantly lower than the low-throughput dialysis group(t=14.725,4.435,7.073,all P<0.05).The total response rate of the low-flux dialysis group was 66.67%,which was significantly lower than the total response rate of 92.00%of the high-flux dialysis group,and the difference was statistically significant(χ^(2)=9.309,P<0.05).Pre-treatment AngII,ET-1,and NO levels were not different between the two groups(all P>0.05);high-throughput dialysis group levels were lower than pre-treatment(P<0.05);and AngII and ET-1 levels of high-throughput dialysis group were significantly lower than low-throughput dialysis levels(t=6.767,15.371,all P<0.05).Conclusion High-flux dialysis significantly improved the clearance rate of β2-MG,AngII and ET-1,and could reduce the micro-inflammatory state of the body,which is of great significance in improving the prognosis.