连续性肾脏替代治疗对老年血液透析患者免疫功能的影响

Effects of continuity renal replacement therapy on immune function in elderly hemodialysis patients

目的探讨连续性肾脏替代治疗(CRRT)对维持性血液透析(MHD)老年患者机体免疫功能的影响。方法选取MHD老年患者60例,随机分为CRRT组和HD组各30例。另选体检健康的老年人10例,作为健康对照组(N组)。分别观察治疗前、后外周血T淋巴细胞亚群和脑钠肽(BNP)的变化。结果 HD组和CRRT组治疗前CD3+、CD4+、CD4+/CD8+比值水平均低于N组(P<0.05),BNP、CD8+水平高于N组,但HD组和CRRT组之间上述指标无显著性差异(P>0.05);治疗后两组CD3+、CD4+、CD4+/CD8+水平升高,BNP、CD8+水平降低,与各自治疗前相比均有显著性差异(P<0.05),且CRRT组改变大于HD组,具有统计学意义(P<0.05);治疗前、后BNP和CD4+/CD8+比值具有相关性(P<0.05)。结论维持性血液透析患者存在免疫功能异常,CRRT和HD均能部分改善患者机体的免疫功能,CRRT在改善机体免疫功能方面优于HD。

Objective To investigate the effect of continuous renal replacement therapy（CRRT） for immune function in elderly maintenance hemodialysis（HD） patients. Methods Selected 60 elderly patients undergoing ma- intenance hemodialysis were divided into CRRT group and HD group of 30 cases. And the physical healthy of the elderly in 10cases as the healthy control group（N group）. The change of peripheral blood T lymphocyte subsets and brain natriuretic peptide （BNP） before and after treatment were observed. Results Compared with Group N,a- mong the patients with maintenance hemodialysis（Group HD and Group CRRT）, CD3 ＋ , CD4＋ , and CD4＋/CD8＋ ra- tio levels before treatment decreased,the levels of BNP and CD8＋ increased （P〈0.05） ;but the above indexes of Group HD were not obviously different with the indexes of Group CRRT （P〈0.05）. After treatment in Group HD and Group CRRT,CD3＋ ,CD4＋ 、CD4＋/CD8 ＋ ratio levels increased,but BNP and CD8＋ levels decreased compared to their pre--treatment. There were significant differences（P〈0.05）. After treatment the differences of the inde- xes existed between Group HD and Group CRRT（P〈0.05）. Before treatment and after treatment BNP and CD4＋ / CD8＋ ratio correlated （P〈0.05）.Conclusion Maintenance hemodialysis with immune dysfunction,CRRT and HD are able to improve some immune function. CRRT in improving immune function is better than HD.