维持性血液透析患者超敏C反应蛋白水平与肺功能的关系

Relationship of high-sensitive C-reactive protein level and lung function in patients with maintenance hemodialysis

目的：探讨维持性血液透析（MHD）患者超敏C反应蛋白（hs-CRP）水平与肺功能的关系。方法选取2011年1月~2013年12月广西壮族自治区梧州市人民医院收治的86例行MHD治疗的慢性肾功能不全患者作为血透组，并选择同期60例体检的正常成人作为对照组，比较两组透析前后的肺功能相关指标[6 min步行试验（6MWT）、肺活量（VC）、用力肺活量（FVC）、第1秒用力呼气量（FEV1）、FEV1/FVC、最大呼气中段平均流速（MMEF）、呼气峰值流速（PEF）]。采用免疫透射比浊法测定患者的hs-CRP水平，以hs-CRP≥3 g/L作为微炎症水平参考值，比较不同hs-CRP水平血液透析患者肺功能相关指标，并探讨血液透析患者hs-CRP水平与肺功能的关系。结果血透组透析前6MWT、VC、FVC、FEV1、FEV1/FVC、MMEF及PEF与对照组比较，差异有统计学意义（P〈0.05或P〈0.01）；血透组透析后6MWT、FEV1、FEV1/FVC、MMEF及PEF与对照组比较，差异有高度统计学意义（P〈0.01）；血透组透析后6MWT、VC、FVC、FEV1、FEV1/FVC、MMEF及PEF与同组透析前比较，差异有高度统计学意义（P〈0.01）。不同hs-CRP水平血液透析患者6MWT、VC、FVC、FEV1、FEV1/FVC、MMEF及PEF比较，差异有统计学意义（P〈0.05或P〈0.01）。血液透析患者hs-CRP水平与6MWT、VC、FVC、FEV1、FEV1/FVC、MMEF及PEF呈中等或强的负相关关系（P〈0.05或P〈0.01）。结论 MHD患者存在一定的微炎症状态，微炎症状态将给MHD患者的肺功能带来负面影响，临床医师在对患者进行血透时，应注重控制微炎症状态，以改善患者的肺功能状况。

Objective To explore relationship of high-sensitive C-reactive protein （hs-CRP） level and lung function in patients with maintenance hemodialysis （MHD）. Methods 86 chronic renal insufficiency patients with MHD from Jan-uary 2012 to December 2013 in People’s Hospital of Wuzhou City in Guangxi Zhuang Autonomous Region were select-ed as hemodialysis group. 60 cases of normal adult in the same period were selected as control group. Pulmonary func-tion indexes [6 min walk test （6MWT）, vital capacity （VC）, forced vital capacity （FVC）, forced expiratory volume in 1 s （FEV1）, FEV1/FVC, average peak expiratory flow rate in the middle （MMEF）, peak expiratory flow （PEF）] were com-pared before and after hemodialysis between two groups. Level of hs-CRP in patients with hemodialysis were detected by immunological transmission turbidimetry. hs-CRP ≥ 3 g/L as reference value of microinflammatory. Pulmonary function indexes in hemodialysis patients with different hs-CRP levels were compared. Relationship of hs-CRP level and pulmonary function in patients with hemodialysis was explored. Results 6MWT, VC, FVC, FEV1, FEV1/FVC, MMEF, PEF in hemodialysis group before hemodialysis and control group were compared, with statistical difference （P〈0.05 or P〈0.01）. 6MWT, FEV1, FEV1/FVC, MMEF, PEF in hemodialysis group after hemodialysis and control group were compared, with significantly statistical difference （P〈0.01）. 6MWT, VC, FVC, FEV1, FEV1/FVC, MMEF, PEF in hemodialysis group after hemodialysis and same group before hemodialysis were compared, with significantly statistical difference （P〈0.01）. 6MWT, VC, FVC, FEV1, FEV1/FVC, MMEF, PEF in hemodialysis patients with different hs-CRP levels were compared, with statistical difference （P〈 0.05 or P〈 0.01）. hs-CRP levels in hemodialysis patients had moderate or strong negative correlation with 6MWT, VC, FVC, FEV1, FEV1/FVC, MMEF, PEF （P〈 0.05 or P〈 0.01）. Conclusion There are some micro-inflammatory state in MHD patients, micro-inflammatory state will adversely affect on lung function in MHD patients, clinicians should pay attention to control micro-inflammatory state when patients undergoing hemodialysis, so as to improve lung functional status of patients.