不同血管通路对维持性血液透析患者微炎症状态及透析充分性的影响

Effects of Different Vascular Access on Micro-inflammatory Status and Adequacy Dialysis of Patients with Maintenance Hemodialysis

目的探讨不同血管通路对维持性血液透析患者微炎症状态及透析充分性的影响。方法选取2015年1月—2016年1月收治的87例需长期维持血液透析患者作为研究对象,按照透析治疗血管通路将其分为A组、B组和C组,每组29例,A组患者予自体动静脉瘘为血管通路,B组患者予中心静脉置管为血管通路,C组患者予颈内静脉带袖套隧道导管为血管通路,透析4周后,观察比较3组患者治疗前后体内C-反蛋白(CRP)、白介素-6(IL-6)、人血白蛋白(ALB)和血红蛋白(Hb)浓度及血液透析充分性和并发症的发生情况。结果与治疗前比较,A组治疗后CRP、IL-6降低,ALB、Hb升高(P<0.05);B组和C组治疗后CRP、IL-6、ALB及Hb均升高(P<0.05)。治疗后A组CRP、IL-6低于B组和C组,而ALB、Hb高于B组和C组(P<0.05)。A组和C组Kt/V值高于B组(P<0.05)。A组总并发症发生率明显低于B组和C组(P<0.05)。结论自体动静脉瘘血管通路维持性血液透析患者CRP、IL-6等促炎因子水平较低,且其透析充分性良好,并发症较少,可考虑作为临床维持性血液透析患者的首选血管通路。

Objective To investigate effects of different vascular access on micro-inflammatory status and adequacy dialysis of patients with maintenance hemodialysis. Methods A total of 87 patients with long-time maintenance hemodialysis admitted between January 2015 and January 2016 were divided into group A, B and C （ n -- 29 for each group） according to dialysis methods for vascular access. Group A received autogeneic arteriovenous fistula as vascular access; group B was given central venous catheter as vascular access; group C was given internal carotid vein tunneled cuffed catheter as vascular access. After 4 weeks of dialysis, c-reactive protein （CRP）, interleukin-6 （IL-6） , albumin （ALB） prepared from human plasma and hemoglobin （Hb） concentrations, condition of adequacy dialysis and incidence rate of complications were observed in three groups. Results Compared with those before treatment, CRP and IL-6 lev- els were decreased, while ALB and Hb levels were increased after treatment in group A （P 〈 0.05） ; CRP, IL-6, ALB and Hb levels were increased after treatment in group B and C （P 〈0.05）. After treatment, CRP and IL-6 levels were lower, while Hh and ALB levels were higher in group A than those in group B and C （ P 〈 0. 05）. Kt/V values in group A and C were significantly higher than those in group B （ P 〈 0.05 ）. Total incidence rate of complications in group A was significantly lower than those in group B and C （P 〈 0.05）. Conclusion Autogeneic arteriovenous fistula for mainte- nance hemodialysis patients can achieve lower CRP and IL-6 levels of pro-inflammatory factors, good adequacy dialysis and less incidence rate of complications. It can be used as preferred vascular access way in treatment of patients with ma- intenance hemodialysis.