超纯透析对维持性血液透析患者炎症状态及营养状况的影响

Effects of ultra-pure dialysis on the inflammatory status and nutritional status in maintenance hemodialysis patients

目的探讨超纯透析对维持性血液透析(MHD)患者血BUN、Scr、UA、Alb、Hb、Hct、CRP、β2-MG、Ca、P、iPTH水平的影响。方法选择本院52例血液透析(HD)患者,改造前使用一级反渗透及自配透析液,透析时间>1年,检测其上述观察指标。随机分为两组,每组26例,纯水组:改造后使用二级反渗透系统,并使用厂家专供A、B透析浓缩液;超纯组:纯水透析的基础上,透析机后安置EF-020微粒子过滤器获取超纯透析液。跟踪观察纯水组及超纯组治疗3、6个月后各观察指标的变化。结果专供透析液及超纯透析液细菌菌落数少于自配透析液(P<0.01)。纯水组及超纯组分别治疗3个月后,血Alb、Hb、Hct水平提高(P<0.01),3、6个月治疗组间比较无统计学差异(P>0.05);血BUN、Scr、UA、Ca、P、iPTH及β2-MG水平无统计学差异(P>0.05)。提高反渗水及透析液纯度后,CRP水平降低明显(P<0.01);3、6个月组间比较均有统计学差异(P<0.01,P<0.05)。纯水组及超纯组治疗6个月后,上述观察指标水平比较均无统计学差异(P>0.05)。结论提高透析用水和透析液纯度可减少透析过程中的单核细胞的活化,降低促炎症介质的释放,并能持续降低炎症状态,低蛋白血症及贫血状况均有明显改善,有效提高透析质量。

Objective To investigate the effects of ultra-pure dialysis on the levels of serum BUN, Scr, UA, Alb, Hb, Hct, CRP, β2-MG, Ca, P and iPTH in maintenance hemodialysis patients. Methods Fifty-two hemodialysis pa- tients in our hospital were chosen, who were used first-stage reverse osmosis and self-dispose dislysis solution and were measured the mentioned observations before reconstruction, whose duration of dialysis exceed one year. They were divided into two groups randomly, 26 cases in each group. Pure water group： to use second-stage reverse osmosis system after re- construction of water management system and A, B concentrated dialysate provided by manufacturers. Ultra-pure group ： on the basis of pure water dialysis, EF-020 mircoparticulate filter which was located in dialysis machine, obtain ultra-pure dia- lysate. We followed up observe changes above mentioned observations after 3-6 months of treatment in pure and ultra-pure water group. Results The levels of serum Alb, Hb, Hct increased remarkably after 3 months of treatment in pure and ul- tra-pure water group respectively and there were significant differences （ P 〈 O. O1 ）. But it didn＇t show significant differ- ences （P 〉0.05） between 3 months and 6 months treatment and there weren＇t significant differences on level of serum BUN, Scr, UA, Ca, P, iPTH and β2-MG. The CRP level decreased remarkably through enhancing the purity of reverse osmosis water and dialysis solution and showed significant differences （ P 〈 0.01 ） after 6 months treatment in pure water group and 3 months treatment in ultra-pure water group. The CRP level decreased further after 6 months treatment in pure and ultra-pure water group and both showed significant differences （P 〈0.01, P 〈 0.05 ） between 3 months and 6 months treatment. After 6 months treatment in pure and ultra-pure water groups, all mentioned observations didn＇t showed signifi- cant differences （P 〉 0.05 ）. Conclusions To improve dialysis water and dialysate purity, which decreased the activation of monocytes and reduced release of pro-inflammatory mediators and depressed the inflammatory state continually. It was improved significantly of accompany with hypoproteinemia and anemia, the quality of dialysis got to enhancement effective- ly.