联机血液透析滤过对维持血液透析患者血IL-1β、IL-6、CRP的影响

The effects of on-line hemodiafiltration on interleukin-1β,interkeulin-6,and C-reactive protein in patients undergoing maintenance hemodialysis

目的探讨联机血液透析滤过(On-line Hemodiafiltration,以下简称联机OL-HDF)清除维持血液透析患者血白细胞介素(IL)-1β、IL-6、C反应蛋白(CRP)的有效性和安全性。方法将66例维持血液透析患者随机分为3组,每组22例,分别进行OL-HDF(OL-HDF组)、高通量血液透析(HPD组)和常规血液透析(CHD组)治疗,观察3个月。选取20名健康体检人群为正常对照组。透析前和每月透析后采患者静脉血测定IL-1β、IL-6、CRP水平,以观察不同透析方式对细胞因子的清除效果。同时比较患者血IL-6水平与血CRP水平的相关性。结果在各组中均未能检测到血IL-1β水平;各组维持血液透析患者血IL-6、CRP水平均明显高于正常对照组(P<0.01);OL-HDF组透析后血IL-6、CRP水平较透析前明显下降(P<0.01);患者血IL-6水平与血CRP水平呈显著正相关(r=0.877,P<0.01)。结论联机OL-HDF对毒素清除较其他透析方式更安全有效,是尿毒症患者的最佳透析方式,值得推广应用。

Objective To investigate the effectiveness removing of interkeulin- 1β（ IL- 1β）, interkeulin- 6 （IL- and safety of online hemodiafiltration （OL- HDF） on 6）, and C- reactive protein （CRP） in patients undergoing maintenance hemodialysis. Methods Sixty - six patients with ESRD were divided into three groups： OL - HDF group, highpermeable hemodialysis （HPD） group and conventional hemodialysis （CHD） group, the patients in the mentioned above groups received OL - HDF, HPD and CHD, respectively, the results observation lasted for 3 months. Twenty healthy individuals were selected as control group. Before and every month after hemodialysis, the patients＇ vein blood were collected for detecting serum levels of IL- 1β, IL- 6, and CRP levels so as to evaluate the cytokine clearance results of different dialysis modes. At the same time, the correlation between the serum levels of IL- 6 and CRP had also been performed. Results The serum IL - 1β levels could not be detected in all groups. The serum IL- 6 and CRP levels in all maintenance dialysis groups were statisticaly significant higher than those in the control group （ P 〈0.01）. After 3 months＇ treatment, the serum levels of IL- 6 and CRP in OL- HDF group were lower than before （ P 〈0.01）. The serum IL-6 levels were positively associated with serum CRP levels （ r = 0. 877, P 〈 0.01）. Conclusion OL - HDF is more safe and more effective than the other hemodialysis in removing toxin in patients undergoing maintenance hemodialysis. It＇s the best dialysis way in patients with ESRD and is worthy of clinical recommendation.