血液透析滤过对维持性血液透析患者微炎症与营养状态的影响观察与护理

Effect of hemodiafiltration on micro-inflammation and nutritional status in maintenance hemodialysis patients

目的研究血液透析滤过对维持性血液透析患者微炎症和营养状态的影响。方法选择维持性血液透析的终末期肾病患者300例,采用随机数字表法将患者随机分为2组,HDF组和HD组,各150例,分别于治疗前和治疗12周后采血检测2组患者微炎症指标,包括超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、肿瘤坏死因子α(TNF-α),与营养指标,包括血清总蛋白(TP)、血清白蛋白(ALB)及血红蛋白(Hb)的变化。结果 HD组与HDF组患者治疗前hs-CRP、IL-6、TNF-α与TP、ALB及Hb差异均无统计学意义(P>0.05);治疗后,HD组患者hs-CRP、IL-6、TNF-α水平较治疗前无显著改变(P>0.05);HDF组治疗后血hs-CRP、IL-6、TNF-α水平较治疗前均显著下降(P<0.01);HD组和HDF组治疗后较治疗前TP、ALB及Hb均升高(P<0.05)。HDF组治疗后TP、ALB及Hb升高幅度较HD组明显(P<0.05),hs-CRP、IL-6、TNF-α水平下降幅度较HD组显著(P<0.05)。结论 HDF治疗技术可有效清除维持性血液透析患者体内的中大分子炎症因子,改善微炎症状态,提高维持性血液透析患者的营养状态。

Objective To study the effect of hemodiafiltration on micro-inflammation and nutritional status in maintenance hemodialysis patients. Methods A total of 300 terminal renal disease（ ESRD） patients with hemodialysis were randomly divided into HDF group（ n = 150） and HD group（ n = 150）. The blood of serum albumin（ Alb）,total protein（ TP）,hemoglobin（ Hb）,highsensitivity C-reactive protein（ hs-CRP）,interleukin-6（ IL-6） and tumor necrosis factor-α（ TNF-α）levels were determined by a biochemistry analyzer before and after 12 weeks of treatment. Results No significant differences was seen in hs-CRP,IL-6,TNF-α,TP,ALB and Hb between two groups before treatment（ P〉 0. 05）. However,hs-CRP,IL-6 and TNF-α significantly decreased after the treatment in HOF group（ P〈 0. 01） but not in HD group. TP,ALB and Hb significantly increased after the treatment in the 2 groups（ P 〈0. 05）. After the treatment,TP,ALB and Hb were higher in HOF group than in HD group（ P〈 0. 05）,and hs-CRP,IL-6 and TNF-α were lower in HDF group than in HD group（ P 〈0. 05）. Conclusion HDF can effectively clear the macromolecules inflammatory cytokines,alleviate the micro-inflammatory state,and improve nutritional status of MHD patients.