血液透析滤过对维持性血液透析患者血清CRP、IL-6的影响

The effection of hemodiafiltration on maintenance hemodialysis patients' CRP and IL-6

目的:研究血液透析滤过对终末期肾衰竭(ESRD)维持性血液透析(MHD)患者微炎症状态的影响。方法:选择我院透析龄超过6个月的稳定维持性血液透析患者30例,随机分为血液透析滤过组(HDF)15例和常规血液透析组(CHD)15例,两组常规应用血管紧张素转换酶抑制剂(ACEI)和促红细胞生成素(EPO)。两组患者分别在进入实验前及治疗两个月后通过免疫比浊法和酶联免疫吸附法(ELISA)测定患者血清C-反应蛋白(CRP)、白细胞介素6(IL-6)含量,同时测定15例健康志愿者CRP、IL-6血清含量作为对照。结果:①共观察了26例MHD患者(有4例中途退出),其中,HDF组12例,CHD组14例,全部MHD患者血清CRP、IL-6均明显高于健康志愿者(P<0.01)。②HDF组治疗前CRP(16.93+8.28)mg/L、IL-6(33.38+8.15)pg/ml,治疗后CRP(10.76+3.99)mg/L、IL-6(28.82+6.77)pg/L,与用药前比较,差异均有显著性(P<0.05)。CHD组治疗后CRP(18.14+6.94)mg/L、IL-6(37.81+6.82)pg/ml,均显著高于治疗前CRP(14.15+7.97)mg/L,IL-6(27.61+7.61)pg/ml(P<0.05)。结论:①CRP可以作为评价ESRD维持性血液透析患者微炎症状态的标志物。②维持性血液透析患者存在微炎症状态。③HDF结合了HD与HF的优点,可以高效清除中小分子物质,可以降低MHD患者血清中CRP和IL-6含量,对改善患者的微炎症状态有积极意义。

Objective：To study the effects of hemodiafiltration （HDF）on mildly inflammatory ESRD patients undertaking maintenance hemodialysis（MHD）.Methods：Select ed 26 cases from our hospital whose time for maintenance hemodialysis exceeds 6 months and divide them at random into hemodiafihration （HDF） group （12 cases） and convetion hemodialysis （CHD） group （14 cases）.All patients applied ACEI and Epo besides HDF and CHD. The patients serum CRP and IL-6 were detected by immunoturbidimetry and ELISA respectively before and two month after treatment. Simultaneously 15 healthy volunteers＇ serum CRP and IL-6were detected, too. Results： ①The 26 MHD patients were divided into HDF group（12 cases） and CHD group （14 cases）,all the MHD patients＇ CRP and IL-6 turned out higher than the healthy volunteers＇ （P〈0.01）. ②Date of treatment HDF group prior to treament and after the treatment respectively are： CRP （16.93＋ 8.28） mg/L, IL-6（33.38＋8.15） pg/ml,CRP（10.76＋3.99） mg/L, IL-6（28.82＋6.77） pg/L,（P〈0.05,compared with pretreatment）. There was obvious difference either before of after the treatment in CHD group.（P〈0.05）.Conclusion： ①CRP may elevated the mildly inflammatory of MHD patients②ESRD patients undertaking maintenance hemodialysis are mildly inflammatory. ③By the clearance rates of small and median molecular, HDF may reduce the serum CRP and IL-6 of MHD patients and play a significant role in improving the patients＇ mild inflammation.