血液透析联合血液灌流对尿毒症透析患者Hcy、hs-CRP、IL-6、TNF-α水平的影响

Influence of hemodialysis combined with blood perfusion on the level of Hcy, hs-CRP, IL-6, TNF-α in patients with uremia

目的探讨血液透析联合血液灌流对尿毒症透析患者同型半胱氨酸(Hcy)、高敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)水平的影响,以期能为改善尿毒症患者的微炎症状态提供参考。方法选取在我院行维持性血液透析的尿毒症患者50例为研究对象,按照数字表格法分为观察组与对照组各25例,对照组患者给予常规的血液透析治疗,每次4 h,每周3次,观察组采用血液透析联合血液灌流治疗,血液透析次数同对照组,血液灌流每周1次,在血液灌流2 h后停止继续血液透析。观察治疗前、治疗后2个月时的Hcy、hs-CRP、IL-6、TNF-α、血红蛋白、血清白蛋白和前白蛋白水平。结果 Hcy、hs-CRP、IL-6、TNF-α治疗前观察组分别为(31.28±4.53)μmol/L、(12.78±8.17)mg/L、(23.54±9.46)ng/L、(90.07±32.73)ng/L,对照组分别为(32.87±4.20)μmol/L、(12.90±7.34)mg/L、(24.10±8.57)ng/L、(93.74±28.54)ng/L,两组比较差异均无统计学意义(P>0.05);治疗后观察组的Hcy、hs-CRP、IL-6、TNF-α分别为(18.65±3.74)μmol/L、(8.89±2.03)mg/L、(28.65±4.49)ng/L、(113.60±21.44)ng/L,对照组为(34.11±3.58)μmol/L、(17.03±5.76)mg/L、(11.48±8.65)ng/L、(72.36±12.25)ng/L,观察组治疗后均较治疗前明显下降(P<0.05),对照组治疗后hs-CRP、IL-6、TNF-α水平较治疗前有所升高(P<0.05),治疗后Hcy、hs-CRP、IL-6、TNF-α水平观察组明显低于对照组(P<0.05);观察组血红蛋白治疗后较治疗前升高(P<0.05),亦高于对照组治疗后水平(P<0.05)。结论行血液透析的尿毒症患者明显存在微炎症状态及营养不良,联合血液灌流治疗能有效促使炎症因子Hcy、hs-CRP、IL-6、TNF-α的下降,并且改善营养状况。

Objective To explore the influence of hemodialysis combined with blood perfusion on the level of Hcy, hs-CRP, IL-6, TNF-αin patients with uremia. Methods Fifty cases with uremia were divided into observa-tion group （n=25） and the control group （n=25）. Patients in control group were treated with regular hemodialysis, 4 h each time, three times once a week, and patients in observation group were treated with hemodialysis combined with blood perfusion. The blood perfusion was applied one time once a week, and regular hemodialysis was performed af-ter 2 h of hemoperfusion. The levels of Hcy, hs-CRP, IL-6, TNF-α, hemoglobin, serum albumin and pre- albumin were detected before and after 2 months treatment. Results The levels of Hcy, hs-CRP, IL-6, TNF-αin observation group and control group were （31.28 ± 4.53）μmol/L and （32.87 ± 4.20）μmol/L, （12.78 ± 8.17） mg/L and （12.90 ± 7.34） mg/L, （23.54 ± 9.46） ng/L and （24.10 ± 8.57） ng/L, （90.07 ± 32.73） ng/L and （93.74 ± 28.54） ng/L, respectively before treatment （All the P〉0.05）. However, the levels of Hcy, hs-CRP, IL-6, TNF-α in observation group and control group were （18.65±3.74）μmol/L and （34.11±3.58）μmol/L, （8.89±2.03） mg/L and （17.03±5.76）mg/L, （28.65±4.49） ng/L and （11.48±8.65） ng/L, （113.60±21.44） ng/L and （72.36±12.25） ng/L, respectively after treatment, with signifi-cant difference between two groups after treatment （All the P〈0.05）. The levels of Hcy, hs-CRP, IL-6, TNF-αin ob-servation group decreased significantly after treatment （All the P〈0.05）, however, the levels of hs-CRP, IL-6, TNF-αin control group increased significantly after treatment （All the P〈0.05）. The level of HGB after treatment was higher than that before treatment in observation group （P〈0.05）, and also higher that in control group after treatment （P〈0.05）. Conclusion Hemodialysis combined with blood perfusion can effectively remove inflammation factor Hcy, hs-CRP, IL-6, TNF-α, and improve the nutritional status.