常规血液透析和高通量血液透析对维持性血液透析患者微炎症状态及营养状况的影响

Effects of routine hemodialysis and high flux hemodialysis on the micro inflammatory state and nutritional status of patients with maintenance hemodialysis

目的：探讨常规血液透析和高通量血液透析不同透析方式对维持性血液透析患者微炎症状态及营养状况的影响。方法选取2014年2月至2016年2月符合研究选取标准的68例行维持性血液透析治疗的慢性肾脏病患者，根据入院先后顺序分为研究组与对照组，每组34例。对照组实施常规血液透析治疗，研究组实施高通量血液透析治疗。对比两组透析前后血红蛋白、血浆白蛋白水平、主观综合性营养评估结果、炎症指标、肌酐、尿素氮、甲状旁腺激素及β2微球蛋白水平变化情况。结果透析前两组血红蛋白及血浆白蛋白水平比较差异未见统计学意义（P ﹥0.05）。经治疗，研究组各指标均较透析前明显改善，对照组血红蛋白水平有所提高，但血浆白蛋白水平无明显变化，研究组各指标优于对照组，差异有统计学意义（P ﹤0.05）。透析前两组营养良好率、轻中度营养不良率及重度营养不良率对比差异未见统计学意义（P ﹥0.05）。经治疗，研究组营养良好率明显高于对照组，差异有统计学意义（P ﹤0.05）。透析前两组 C-反应蛋白及白细胞介素-6水平比较差异未见统计学意义（P ﹥0.05）。经治疗，研究组各指标均较治疗前显著改善，且优于对照组，差异有统计学意义（P ﹤0.05）。透析后两组肌酐、尿素氮均无明显变化，研究组甲状旁腺激素和β2微球蛋白水平均显著降低，对照组甲状旁腺激素水平明显降低，差异有统计学意义（P ﹤0.05）。结论高通量透析可有效清除维持性血液透析治疗患者体内微炎症细胞因子、大中分子毒素，改善其血红蛋白及血浆白蛋白水平，提高营养状态，具有推广价值。

Objective To investigate the effects of routine hemodialysis and high flux hemodialy-sis on the micro inflammatory state and nutritional status of patients with maintenance hemodialysis. Methods From February 2014 to February 2016,68 patients with chronic kidney disease who received maintenance hemodialysis were selected according to the order of admission,and were divided into study group and control group,with 34 cases in each group. The control group was treated by routine hemodial-ysis,and the study group was treated by high flux hemodialysis. Before and after dialysis hemoglobin, the plasma albumin level,subjective and comprehensive nutritional assessment results,inflammation in-dex,creatinine,urea nitrogen,parathyroid hormone and β2 microspheres protein level changes were compared. Results There was no significant difference in the levels of hemoglobin or plasma albumin between the two groups before hemodialysis（P ﹥ 0. 05）. After treatment,the above indexes significantly improved compared with that before dialysis in the study group,the hemoglobin level in the control group increased,but the serum albumin level had no significant changes,each index of the study group was better than that of the control group,the difference was significant（P ﹤ 0. 05）. There was no significant difference between the two groups in the rate of good nutrition,mild to moderate malnutrition rate or se-vere malnutrition rate before hemodialysis（P ﹥ 0. 05）. After treatment,the rate of nutrition of the study group was significantly higher than that of the control group,the difference was significant（P ﹤ 0. 05）. There was no significant difference between the two groups in the C reactive protein and interleukin-6 lev-els before dialysis（P ﹥ 0. 05）. After treatment,the indicators of the study group significantly improved compared with those before treatment,and were better than those of the control group,the differences were significant（P ﹤ 0. 05）. After dialysis,there was no significant difference in the levels of the creati-nine,blood urea nitrogen（BUN）,the levels of parathyroid hormone and β2 microspheres protein in the study group were significantly lower,the parathyroid hormone in the control group was significantly lower, the differences were significant（P ﹤ 0. 05）. Conclusions High flux hemodialysis can effectively remove micro inflammatory cytokines,large and middle molecule toxins in patients with maintenance hemodialy-sis,improve the hemoglobin and serum albumin levels,improve the nutritional status,and has the value of popularization.