醋酸盐和无醋酸碳酸氢盐血透患者外周血IL－6，TNF和淋巴细胞亚群的变化

Circulating levels of IL-6 ,TNF and lympho-cyte subset cells during hemodialysis withconventional acetate and acetate free bicar-honate dialysate

作者系统比较了２０例血透患者应用醋酸盐和无醋酸碳酸氢盐透析液治疗前后白细胞介素－６（ＩＬ－６）、肿瘤坏死因子（ＴＮＦ）和外周血淋巴细胞亚群（ＣＤ４，ＣＤ８）的变化，结果发现：①透析后两组患者外周血ＩＬ－６均有升高，但醋酸盐组更为显著；②ＴＮＦ在醋酸盐透析后明显升高，前后差异显著（Ｐ＜０．０５），而无醋酸碳酸氢盐组改变不明显；③两组患者治疗后外周血淋巴细胞亚群（Ｃ０４／ＣＤ８比值）活性均升高，但前者以ＣＤ４的升高为主，后者以ＣＤ８的降低为主，可能具有不同的临床意义；④通过测定治疗前后β２－微球蛋白（β２－Ｍ）的水平，未发现与ＩＬ－６有直接的联系。作者认为无醋酸碳酸氢盐透析液有其独特的优点，具有临床推广应用的价值。

n recent years. growing interest hasbeen focused in the possible role of cy-tokines in the acute phase response of theinflammatory process ,and many studies re-ported there was correlation between cy-tokines such as interleukinl ( IL-I ) . Inter-leukin-6 (IL-6) and tumor necrosis factor(TNF) etc and acetate dialvsate. In thisstudy ,we attempt to determine the relationship between IL-6 and the acetate dialysate.Twenty patient with end stage renalfailure ,including 12 long term hemodialysiswith acetate dialysate (AHD) and 8 longterm (more than three months) hemodialy-sis with acetate free bicarbonate dialysate(FABIID) were enrolled in this study. Bloodsamples were obtained pre- and post-dialy-sis session immediately and tested for plas-ma IL-6 TNF and CD4 ,CD8 using biologicalassays. Results indicated ①The level of IL-6 was uicreased in eight patients with AHDand three in AFBHD, and no changed infour patients with AHD and five in AFB-HD. ②After dialysis, the concentration ofTNF was higher than that in AHD beforedialysis, and no changed in AFBHD。③Inpatients with AHD. CD4 was significantlyincreased after the end of dialvsis sessionand CD8 had no change. In patients withAFBHD. CD4 had no change, but CD8 wassignificantly decreased at the end of thedialysis observed. From these synthesis ofthe IL-6, TNF etc and T-help cell may bevery closed to some cytokines ,so we highlyrecommend using AFBHD instead of AHDin patients with chronic renal failure.