提升透析液水质改善维持性血液透析患者微炎性反应状态

Upgrade of dialysate quality improves the microinflammation in maintenance haemodialysis patients

目的探讨改善透析液水质对长期血液透析患者微炎性反应状态的影响。方法以53例维持性血液透析（MHD）终末期。肾病患者为对象，前瞻性观察透析液水处理系统升级前后患者病情变化。以脱离血液透析（死亡、转为腹膜透析或肾移植）和（或）生存至入组后8年为观察终点。比较水处理系统升级前后透析液内毒素含量及患者血清白细胞介素6（IL-6）、肿瘤坏死因子仪（TNF-α）、C反应蛋白（CRP）、白蛋白水平等的变化。结果水处理系统和中央供液系统经高频热消毒结合内毒素过滤器升级改造后，与升级前比较，透析液内毒素年平均值显著下降【（0．046±0．012）Eu／ml比（0．454±0．002）EU／ml，P〈0．01】，并在观察期间内维持稳定水平；患者的血清IL．6显著下降[3．947±3．624）ng／L比（13．779±7．106）ng／L，P=0．036】；血清TNF-α显著下降【（7．935±3．864）ng／L比（12．804±8．017）ng／L，P=0．012】；血清CRP年平均值显著下降【（0．194±0．149）mg／L比（0．561±0．309）mg／L，P〈0．01】，并在观察期间内维持稳定水平；血清白蛋白年平均水平显著增加[（41．900±6．803）g／L比（38．140±7．083）g／L，P=0.0421；患者的年平均血红蛋白水平无显著改变，但红细胞生成素应用剂量显著下降[（93．0±12．7）U·kg^-1·周^-1比（131．0±10．1）U-kg^-1·周^-1，P=0．015]。结论采用含双级反渗、高频热消毒以及内毒素过滤器在内的水处理和中央供液系统，能明显提升透析液水质。透析液水质提升显著改善了MHD患者的微炎性反应状态及减少相关并发症的发生。

Objective To explore the effect of upgrade of dialysate quality on the microinflammation in maintenance haemodialysis （MHD） patients. Methods Fifty-three MHD patients in Kidney Center of the First Affiliated Hospital, Medical College, Zhejiang University in January 2003 were enrolled in the prospectively study. The main end-points were survival at 8 years or weaning from haemodialysis during 8-year period including death, receiving renal transplantation or transferring to peritoneal dialysis. The endotoxin level of dialysate and patients＇ serum levels of interleukin-6 （IL-6）, tumor necrosis factor α （TNF-α）, C reaction protein （CRP）, and albumin were recorded during the observation period. Results After the upgrade of water management system, endotoxin level of dialysate obviously decreased [（0.046±0.012） EU/ml vs （0.454±0.002） EU/ml, P〈0.01], and serum IL-6 [（3.947±3.624） ng/L vs （13.779±7.106） ng/L, P=0.036], TNF-α[（7.935±3.864） ng/L vs （12.804±8.017） ng/L, P=0.012] as well as CRP[（0.194 ±0.149） mg/L vs （0.561±0.309） mg/L,P〈0.01] decreased significantly, while serum albumin increased [（41.900±6.803） g/L vs （38.140±7.083） g/L, P=0.042]. Hemoglobin level did not change significantly after the system upgrade, however, the dose of erythropoietin decreased [（93.0±12.7） U·kg^-1week^-1 vs （131.0±10.1） U·kg^-1week^-1, P=0.015]. Conclusions The upgrade of central dialysis fluid delivery and water management system by application of double reverse osmosis, high frequency heat disinfection and endotoxin fiher can improve the quality of dialysate. Improvement of dialysate quality can ameliorate the mieroinflammation state of MHD patients.