维持性血液透析患者营养不良-炎症反应综合征采用血液透析联合血液灌流治疗的效果

Effect of hemoperfusion combined with hemodialysis in treatment of patients with maintenance hemodialysis combined with malnutrition-system inflammatory response syndrome

目的探讨维持性血液透析（MHD）患者营养不良—炎症反应综合征采用血液透析（HD）联合血液灌流（HP）治疗的效果。方法选择维持性血液透析不良—炎症反应综合征患者40例,发病0-3个月给予常规HD治疗每周3次＋基础治疗,第3个月给予HD联合HP治疗,第6个月恢复HD治疗,比较治疗前、治疗后3、6、9个月后各实验室检查指标、主观综合营养评分（SGA）及营养相关测量指标情况。结果 （1）治疗前、治疗3、6、9个月血清白蛋白（ALB）、C反应蛋白（CRP）、白介素-8（IL-8）、肿瘤坏死因子（TNF-α）、血浆瘦素（leptin）水平比较差异有统计学意义（F1=23.68,F2=40.84,F3=83.68,F4=64.76,F4=36.19,均P〈0.05）,应用HP治疗后CPR、IL-8、TNF-α、Leptin水平均明显降低,ALB水平明显增高;（2）治疗前、治疗3、6、9个月营养不良状态分布及SGA评分比较差异有统计学意义（χ^2=9.35,F=10.44,均P〈0.05）,应用HP治疗后40例患者营养不良状态分布及SGA评分均明显改善;（3）治疗前、治疗3、6、9个月体质量指数（BMI）、上臂围（MAC）、上臂肌围（MAMC）及肱三头肌皮褶厚度（TSF）比较差异有统计学意义（F1=9.45,F2=8.17,F3=7.66,F4=8.05,均P〈0.05）,应用HP治疗后BMI、MAC、MAMC、TSF各指标均明显改善。结论 HD联合HP治疗能够有效降低各炎症因子水平,提高ALB含量,改善血液透析营养不良—炎症反应综合征患者的营养状态。

Objective To investigate the effect of hemoperfusion combined with hemodialysis in treatment of patients with maintenance hemodialysis combined with malnutrition-system inflammatory response syndrome. Methods Forty patients were selected,who were treated with routine HD three times a week plus basic treatment during the first three months,then HD combined with HP for three months and HD for another three months. Laboratory examination indexes,subjective comprehensive nutrition evaluation（ SGA） and the nutritional measurement index were compared before treatment and 3,6,and 9 months after treatment. Results① There were significant differences in ALB,CRP,IL-8,TNF-α,leptin levels before treatment and 3,6,9 months after treatment（ F1= 23. 68,F2= 40. 84,F3= 83. 68,F4= 64. 76,F4= 36. 19,P〈0. 05）. After the application of HP,CPR,IL-8,TNF-α,and leptin levels were significantly deceased while ALB levels were significantly increased. ② There were significant differences in malnutrition state distribution and SGA score before treatment and 3,6,9 months after treatment（ χ^2= 9. 35,F = 10. 44,P〈0. 05）. After the application of HP malnutrition state distribution and SGA score in 40 patients were significantly improved. ③There were significant differences in BMI,MAC,MAMC and TSF before treatment and 3,6,9 months after treatment（ F1= 9. 45,F2= 8. 17,F3= 7. 66,F4= 8. 05,P〈0. 05）. After the application of HP,BMI,MAC,MAMC,TSF indices were significantly improved. Conclusions HD plus HP therapy can effectively reduce the inflammatory factor levels,increase ALB,and improve the nutritional status of patients with maintenance hemodialysis combined with malnutrition-system inflammatory response syndrome.