高通量透析与传统血液透析对透析患者微炎症和凝血的影响

Effect of high flux Hemodialysis and Conventional Hemodialysis on Micro Inflammation and Coagulation in Dialysis Patients

目的观察高通量透析与传统血液透析对透析患者微炎症和凝血的影响。方法选取40例接受高通量透析治疗患者作为研究组,并选择40例接受常规血液透析患者作为对照组。对两组患者治疗前和治疗6个月后的尿素氮(BUN)、甲状旁腺激素(PTH)改变,并比较两组患者的微炎症指标(血清C反应蛋白、白细胞介素-6、肿瘤坏死因子α)与凝血指标(a PTT、PA、PT、TT、Fbg)。结果 1治疗前后两组BUN水平差异不显著,但治疗后研究组PTH含量(252.8±69.1)pg/L显著性低于对照组(294.2±72.4)pg/L,差异有统计学意义(P<0.05);2两组患者治疗前血清C反应蛋白、白细胞介素-6及肿瘤坏死因子α含量接近,但治疗后研究组分别为(6.8±2.1)mg/L、(31.2±6.1)ng/L和(1.1±0.9)ug/L,均显著性低于对照组(20.4±8.7)mg/L、(47.1±8.7)ng/L和(12.2±1.9)ug/L,差异有统计学意义(P<0.05);3治疗前两组凝血指标无显著差异(P>0.05),但研究组凝血时间长于对照组。30 min后血浆PT、a PTT、TT延长,而PA降低,Fbg呈上升趋势。对照组PT无明显改变,PA仅在30 min出现轻微下降,120 min后开始上升,120、240 min时PA值显著高于0 min(P<0.05),a PTT 30 min时延长,与0 min时比较差异显著(P<0.05),后逐渐恢复至原水平,TT与Fbg各时间段均保持递增趋势。结论与对传统血液透析相比,高通量透析可以有效清除患者血液中的大分子毒素以及微炎症因子,具有显著抗凝效果,临床效果优异。

Objective To investigate the effects of high flux hemodialysis and conventional hemodialysis on micro inflammation and coagulation in dialysis patients. Methods 40 patients received high flux hemodialysis patients as research group,and select 40 patients undergoing regular hemodialysis as control group.Observe two groups of patients before treatment and after 6 months（ predialysis） BUN,PTH change,and compare the two groups of patients with micro inflammatory markers（ serum C reactive protein and interleukin-6,TNF-alpha）,coagulation index records（ a PTT,PA,PT,TT,Fbg）. Results the difference between the two groups before and after treatment of urea nitrogen levels was not significant,but the treatment group after the study parathyroid hormone level（ 252. 8 ± 69. 1） pg / L were significantly lower than those in control group（ 294. 2 ± 72. 4） pg /L,the difference was statistically significant（ P 〈 0. 05）; in the two groups before treatment the serum C-reactive protein and interleukin-6 and tumor necrosis factor alpha content close to,but after treatment,study group were（ 6. 8 ± 2. 1） mg / L,（ 31. 2 ± 6. 1） ng / L and（ 1. 1 ± 0. 9） ug / L,were significantly lower than those of the control group（ 20. 4 ± 8. 7） mg / L,（ 47. 1 ± 8. 7） ng / L and（ 12. 2 ± 1. 9） ug / L. Difference also had statistical significance（ P 〈 0. 05）; the two groups had no significant difference in coagulation indexes before treatment（ P 〉 0. 05）,prolonged plasma PT,a PTT,TT of group 30 min,and PA decreased,Fbg increased. Control group PT had no obvious change,PA showed a slight drop in 30 min alone,120 min began to rise,120,240 min when the PA value was significantly higher than that of 0 min（ P 〈 0. 05）,a PTT 30 min and 0 min were significantly prolonged,difference was significant（ P 〈 0. 05）,then gradually restored to the original level,TT and Fbg each time all keep increasing trend. Conclusion Compared with the conventional hemodialysis,high flux hemodialysis can effectively remove big molecule toxins in the blood of a patient and micro inflammatory factor has significant anticoagulant effect,excellent clinical effect.