血液灌流对维持性血液透析患者微炎症状态的影响

Effects of Hemoperfusion on Micro- inflammation in Maintenance Hemodialysis Patients

目的：探讨血液透析联合血液灌流治疗对维持性血液透析患者微炎症状态及脂蛋白a的影响。方法选择我院血液净化中心维持性血液透析患者89例，随机分为治疗组（ HD＋HP组，男25例、女21例）和对照组（ HD组，男23例、女20例）。另选择30名健康人作为正常组，监测治疗前后血清超敏C反应蛋白（hypersensitive C-reactive protein，hs-CRP）、白介素-6（interleukin-6，IL-6）、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）、脂蛋白a（ lipoprotein-a，LP-a）的变化。结果 MHD患者普遍存在微炎症状态及LP-a代谢紊乱，与正常组对比，MHD患者hs-CRP、IL-6、TNF-α、LP-a等指标水平均显著升高（ P﹤0.01）；对照组血液透析治疗12周后hs-CRP、IL-6、TNF-α及LP-a水平较透析前升高（ P﹤0.05）；与对照组相比，治疗组血液灌流治疗12周后hs-CRP、IL-6、TNF-α等炎症因子水平明显降低（ P﹤0.05），LP-a水平亦显著降低（ P﹤0.05）。结论 MHD患者普遍存在微炎症状态及LP-a代谢紊乱；血液灌流治疗可减轻MHD患者微炎症状态及改善LP-a代谢紊乱。

Objective To investigate the effects of hemodialysis with hemoperfusion on micro -inflammatory state and Lipoprotein-a（ LP-a）. Methods 89 patients undergoing maintenance hemodialysis were randomly divid-ed into treatment group（ HD＋HP group,25 males and 21 females）and control group（ HD group,23 males and 20 fe-males）. 30 healthy adults were selected as healthy control group. Hypersensitive C-reactive protein（ hs-CRP）,in-terleukin-6（IL-6）,tumor necrosis factor-α（TNF-α）,lipoprotein-a（LP-a）were measured before and after treatment. Results Micro-inflammatory state and LP-a disorder were common in MHD group. Hs-CRP,IL-6, TNF-α and LP-a were significantly higher in MHD patients than those in healthy normal controls（P﹤0. 01）. Hs-CRP,IL-6,TNF-α and LP-a were significantly higher in control group 12 weeks after hemodialysis（P﹤0. 05）. Hs-CRP,IL-6,TNF-α and LP-a decreased significantly in treatment group than those in control group 12 weeks after hemodialysis（P﹤0. 05）. Conclusion The micro-inflammatory status and disturbance of LP-a metabolism are common in MHD patients. Hemoperfusion can alleviate micro-inflammatory status and improve LP-a metabolic disorders.