高通量血液透析改善尿毒症预后机制研究

The clinical research of high-flux hemodialysis for improvement of prognosis in patients with uremia

目的探讨高通量血液透析(HFHD)改善尿毒症患者预后及可能机制。方法选择1998年4月至2009年8月大连市中心医院血液净化中心收治的33例尿毒症患者,检测HFHD治疗前及治疗后6个月超声心动图、肌电图及生化指标,分析比较各指标变化及相关性。结果与治疗前比较,HFHD治疗6个月后,血清白蛋白(ALB)、高密度脂蛋白胆固醇(HDL-C)上升,血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、晚期糖基化终末产物(AGEs)、β2微球蛋白(β2-MG)、白介素-6(IL-6)下降;患者心脏舒张功能得到改善;腓肠神经传导速度和动作电位的波幅提高;血管内皮依赖性舒张功能无进一步减低。相关性分析显示,ALB水平与AGEs、IL-6呈负相关,内皮依赖性血管舒张功能与β2-MG呈负相关、与HDL-C呈正相关,腓肠神经传导速度与β2-MG呈负相关,腓肠神经动作电位的波幅与AGEs呈负相关。结论 HFHD可以改善尿毒症患者的营养及脂代谢,改善尿毒症患者心脏的舒张功能,改善尿毒症患者的周围神经病变,延缓血管内皮功能的进一步损害,这些可能与HFHD有效清除了β2-MG、AGEs、IL-6等中大分子毒素及炎症因子有关。

Objective To explore whether high-flux hemodialysis （HFHD） can improve the prognosis in patients with uremia and the possible mechanism. Methods Thirty-three uremia patients in Dalian Central Hospital were selected and changed treatment of 6-month HFHD, with themselves as controls （0 month）. After 6 months, the indexes of chocardiographic, electromyography and biochemical examination were detected in patients. Meanwhile, the cardiac construction and function, vascular endothelial function and peripheral nerve function were measured. Thereafter, the changes and association of each index were then analyzed and compared. Results After HFHD treatment of 6 months, ALB and HDL-C were increased but TC, LDL-C, AGEs, β2-MG and IL-6 decreased. The heart diastolic function of patients was improved and the sural nerve conduction velocity and sural nerve wave amplitude increased. Furthermore, the endothelium-dependent vasodilatation function had no further decrease. The association analysis showed that the ALB level was negatively correlated with AGEs/ IL-6. The endothelium-dependent vasodilatation function was negatively correlated with β2-MG but positively with HDL-C. The sural nerve conduction velocity was negatively correlated with β2-MG, while the sural nerve wave amplitude was negatively correlated with AGEs. Conclusion HFHD could improve the nutritional status,lipid metabolism, heart diastolic function and peripheral neuropathy of uremic patients so as to postpone the further damage of vascular endothelial function, which might be correlated with that HFHD effectively removed plasma middle and maeromolecule toxins and inflammatory factors such as β2-MG,AGES and IL-6.