尿毒症患者血液透析治疗对瘦素和神经肽Y水平的影响

The Effect of Hemodialysis on the Levels of Plasma Leptin and Serum Neuropeptide Y in Uremia Patients

研究尿毒症患者血液透析前后血浆瘦素和血清神经肽Y(NPY)的变化,探讨改善尿毒症营养不良的有效措施。本文尿毒症患者69例,分为3组:低通量纤维素膜透析组(A组)32例,低通量血仿膜F6透析组(B组)21例,F60高通量血滤器透析滤过并血液透析组(C组)16例。对照组18名。用RIA测定患者透析前、后及对照组血浆瘦素及血清NPY水平。结果三组瘦素与NPY水平透析前明显高于对照组(P<0.01);透析后A、B组瘦素、NPY水平未降低,C组瘦素水平明显降低(P<0.05),但NPY无显著变化。尿毒症患者存在高瘦素及NPY血症,二者无相关性,都不能通过单纯血液透析清除。利用高通量血滤器进行血液滤过有助于增加瘦素的清除率,改善患者营养状态。

To evaluate the changes of plasma leptin and serum neuropeptide Y （NPY） levels in uremia patients after hemodialysis and to discuss the efficient method on improving uremia malnutrition. 69 uremia patients were divided into 3 groups： Group A with 32 patients using low- flux cellulosic dialyzer, Group B with 21 patients using low-flux polysulfone dialyzer（F6）, and Group C with 16 patients using high-flux polysulfone dialyzer （F60） and blood dialyzer. 18 healthy volunteers were chosen as the control group. The plasma leptin and serum NPY levels were detected by RIA in uremia patients before and after dialysis and in control group. Compared with control, all uremia patients had obviously higher leptin and NPY levels before dialysis （P〈0.01） ; Leptin and NPY levels in group A and B did not change after dialysis. The leptin levels were significantly decreased in group C after dialysis （P〈0.05）, but NPY levels did not change. There was no correlation between higher levels of leptin and NPY in uremia patients. They could not be cleared by hemodialysis alone. Hemo-filtration with high flux polysulfone dialyzer could increase the clearance efficiency of leptin and improve nutritional conditions for uremia patients.