不同透析方式及透析龄对终末期肾病患者微炎症状态的影响及临床意义

Effects of different dialysis approaches and duration on microinflammation in end-stage renal disease patients

目的研究不同透析方式、透析龄对终末期肾病患者微炎症状态的影响及微炎症状态与患者营养状态、贫血、心功能等的关系。方法以45例维持性血液透析患者(HD组)、38例维持性腹膜透析患者(PD组)、25例终末期肾病非透析患者(非透析组)及30例健康志愿者(正常对照组)为研究对象,并将维持性血液透析及维持性腹膜透析患者按透析龄分别分为透析龄<2年组及透析龄>2年组两个亚组。分别采集空腹静脉血检测C反应蛋白(CRP)、血肌酐(Scr)、尿素氮(BUN)、白蛋白(Alb)、血红蛋白(Hb)、血清铁(SF)、脂蛋白a[LP(a)]、B型钠尿肽(BNP)等,并行心脏彩超测定左心室射血分数(LVEF)。结果 (1)终末期肾病患者HD组、PD组、非透析组CRP水平明显高于正常对照组,HD组及PD组CRP水平高于非透析组,差异均有统计学意义(P<0.05)。(2)PD组CRP水平低于HD组,差异有统计学意义(P<0.05)。HD组透析龄<2年组CRP水平低于透析龄>2年组,差异有统计学意义(P<0.05)。PD组透析龄<2年组CRP水平与透析龄>2年组比较,差异无统计学意义(P>0.05)。(3)终末期肾病患者(包括HD组、PD组及非透析组),CRP水平与Scr、SF水平无相关关系(P>0.05),与Hb、Alb、LP(a)呈线性相关关系(P<0.05)。(4)终末期肾病并心力衰竭患者(包括HD组、PD组及非透析组),CRP水平随心功能恶化而逐渐升高,每组间差异均有统计学意义(P<0.05)。终末期肾病并心力衰竭患者CRP水平与LVEF呈负相关关系(P<0.05),与血浆BNP呈正相关关系(P<0.05)。结论终末期肾病患者普遍存在微炎症状态,微炎症状态与心力衰竭、营养不良、贫血等密切相关,血液透析患者微炎症反应较腹膜透析患者严重,且随透析龄延长而加重。

Objective To investigate effects of different dialysis approaches and duration on microinflammation in end- stage renal disease patients and its association with patients＇ nutritional status,anemia and heart function. Methods45 hemodialysis（ HD） patients,38 peritoneal dialysis（ PD） patients and 25 non- dialysis patients with end- stage renal disease and 30 healthy volunteers were enrolled in the study. Hemodialysis and peritoneal dialysis patients were divided into two subgroups（ Group 1,duration of dialysis 2 years and Group 2,duration 2 years）. Fasting venous blood were collected to detect C- reactive protein（ CRP）,serum creatinine（ Scr）,blood urea nitrogen（ BUN）,albumin（ ALB）,hemoglobin（ Hb）,serum ferritin（ SF）,lipoprotein a（ LP（ a））,B- type natriuretic peptide（ BNP）,etc.Left ventricular ejection fraction（ LVEF） was measured by echocardiography. Results（ 1） In patients with end- stage renal disease（ including the HD group,PD group,and the non- dialysis group）,CRP levels were significantly higher than that in the control group,with levels in the HD group and PD group higher than that in the non- dialysis group（ P 0. 05）.（ 2） CRP level in the PD group was lower than in the HD group（ P 0. 05）. CRP level in the HD1 group（ duration of dialysis 2 years） was lower than that in the HD2 group（ duration of dialysis 2 years）（ P 0. 05）. CRP level in the PD1 group（ duration of dialysis 2 years） was similar to that in the PD2 group（ duration of dialysis 2 years）（ P 0. 05）.（ 3） In patients with end- stage renal disease（ including the HD,PD and non- dialysis groups）,CRP levels were not correlated with Scr,SF levels（ P 0. 05）,but negatively correlated with Hb,ALB,LP（ a）（ P 0. 05）.（ 4） In end- stage renal disease patients with concurring heart failure（ including HD group,PD group and the non- dialysis group）,CRP levels were elevated with deteriorating heart function（ P 0. 05）. In ESRD patients with heart failure CRP levels were negatively correlated with LVEF（ P 0. 05）,and positively correlated with plasma BNP（ P 0. 05）.Conclusion Microinflammatory state is common in ESRD patients. And imcroinflammatory state is closely related to heart failure,malnutrition,anemia,etc. Microinflammation in HD patients are more severe than patients on PD,which aggravates with increasing duration of dialysis.