持续低流量血液透析滤过在移植肾功能恢复延迟中的应用

Application of HRRT in delayed graft function after kidney transpiantation

目的观察移植肾功能恢复延迟（DGF）的受者应用持续低流量血液透析滤过（SLEDF）治疗的效果。方法术后发生DGF的肾移植受者33例，其中15例采用SLEDF法行肾脏替代治疗（SLEDF组），18例采用普通血液透析治疗（血透组）。测定治疗前后两组肾功能，补体C3、C4，C反应蛋白（CRP），以及白细胞介素（IL）一1β、IL-6和肿瘤坏死因子a（TNF-a）的水平。结果SLEDF组受者移植肾功能恢复时间为治疗后（29±13）d，血透组为治疗后（47±21）d。两组治疗后血肌酐和尿素氮水平均低于治疗前（P〈0．01）；两组治疗后IL-tβ、IL-6和TNF-a水平低于治疗前，且治疗后SLEDF组低于血透组（P〈0．05）；治疗后两组补体和CRP水平有所降低，但与治疗前相比较，差异无统计学意义（P〉O．05）。结论SLEDF的杂合式。肾脏替代治疗可有效降低受者体内血肌酐、尿素氮和部分细胞因子水平，有利于移植肾功能恢复，可作为DGF受者过渡期的肾脏替代治疗方法。

Objective To observe the effect of hybrid renal replacement therapy （sustained low- efficiency hemodiafiltration） in recipients with delayed graft function （DGF） after kidney transplantation. Methods In 33 kidney transplant patients with DGF, there were 15 cases subject to sustained low-efficiency hemodiafiltration （SLEDF group）, 18 cases subject to hemodialysis （ HD group）. The renal function was tested, and the expression levels of complements C3, CA, and CRP, IL-Iβ, IL-6, TNF-a were detected before and after therapy. Results In SLEDF group, the renal function recovered in （29 - 13） days after therapy, and in （47 - 21） days in HD group. After therapy, the BUN and Scr in both two groups were lower than before （P〈0. 01）. After therapy, the levels of IL-lβ, IL-6 and TNF-a were also lower than before in two groups, and the levels were lower in SLEDF group than in HD group （P〈0. 05）. The levels of complements C3, CA, and CRP in two groups were decreased after therapy, but there was no statistically significant difference （P〉0. 05）. Conclusion SLEDF can decrease the level of SCr, BUN and some cytokines in recipients effectively, and It＇s helpful to recovery of the renal function. SLEDF can be used by DGF recipients in transit time.