高通量透析联合不同频率血液灌流对维持性血液透析患者微炎症状态和钙磷代谢的影响

The effect of high-flux hemodialysis combined with various frequencies of hemoperfusion on micro-inflammatory status and calcium-phosphorus metabolism in patients with maintenance hemodialysis

目的探讨高通量透析联合不同频率血液灌流对维持性血液透析患者微炎症状态和钙磷代谢的影响。方法选择维持性血透患者80例,按随机数字法分为4组各20例,A组为高通量血液透析,其余三组在此基础上联合不同频率血液灌流,B组1次/周,C组1次/2周,D组1次/4周,另选同期健康人群20例为对照组。分别于治疗前以及治疗24周后测定患者血超敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)、白蛋白(Alb)、血红蛋白(Hb)、血钙、钙磷乘积(Ca×P)、甲状旁腺激素水平(i PTH)等指标。结果四组患者治疗后hs-CRP、IL-6、TNF-α、Ca×P、i PTH水平均低于治疗前,但高于对照组;治疗后Alb、Hb水平均高于治疗前,但低于对照组(P<0.05)。B、C、D组疗效均优于A组(P<0.05)。结论高通量透析联合不同频率血液灌流能改善维持性血透患者微炎症状态和钙磷代谢紊乱。

Objective To investigate the therapeutic effect of high-flux hemodialysis combined with various frequencies of hemoperfusion on micro-inflammatory status and calcium-phosphorus metabolism in patients with maintenance hemodialysis（ MHD）.Methods Eighty patients with MHD were randomly divided into four groups,20 in each group.In group A,patients received HFHD only while the patients in group B,C and D received HFHD with different frequencies of hemoperfusion（ HP ＋HD）,in which HP was performed once a week in the group B,once every two weeks in the group C and once every four weeks in group D.A normal control group consisting of 20 healthy people was included.The serum levels of hs-CRP,IL-6,TNF-α,Hb and Alb in all patients and controls were detected by ELISA before and after the treatments.Serum calcium,phosphorus and i PTH were measured before treatment and 24 weeks after the treatment,respectively. Results The serum levels of hs-CRP,IL-6,TNF-α and calcium-phosphorus product and i PTH in the four treatment groups after treatment were significantly less than before treatment and higher than those in the control group（ all P〈 0. 05）.Meanwhile,Hb and Alb levels after all treatments were increased significantly when compared to before treatment.Overall,there were significant differences between high-flux hemodialysis and various hemoperfusion frequencies（ P 〈0. 05） and they were tightly associated with the frequency of HP（ P 〈0. 05）.Conclusion Micro-inflammatory status was effectively reduced and calcium-phosphorus metabolism was improved by HFHD combined with different frequencies of HF.