高通量血液透析联合左卡尼汀改善尿毒症患者免疫功能的影响

Impact of the treatment of high-flux hemodialysis combined with L-carnitine on the immune function in patients with uremia

目的观察高通量血液透析联合左卡尼汀改善尿毒症的疗效及其对免疫功能的影响。方法选择2014年10月至2015年10月治疗的尿毒症患者160例,随机分为观察组和对照组,每组80例。对照组予以高通量透析治疗,观察组在对照组的基础上予以左卡尼汀治疗。观察两组治疗后的疗效,治疗前后尿素氮(BUN),血肌酐(SCr),血红蛋白(Hbg),血清白蛋白(Alb),白介素(IL)-2,IL-4,IL-10,干扰素(INF)-γ,CD3^+,CD4^+,CD8^+和CD4^+/CD8^+水平变化。结果观察组的总有效率为93.75%,明显高于对照组的81.25%,差异有统计学意义(P<0.05)。两组治疗前BUN,Ccr,Scr,Hbg,Alb,IL-2,IL-4,IL-10,INF-γ,CD3^+,CD4^+,CD8^+和CD4^+/CD8^+水平差异无统计学意义(P>0.05)。两组治疗后BUN,Scr,IL-2,INF-γ和CD8^+水平较治疗前明显降低(P<0.01),Ccr,Hbg,Alb,IL-4,IL-10,CD3^+,CD4^+和CD4^+/CD8^+水平较治疗前明显升高(P<0.01),而观察组各指标水平变化更为明显(P<0.05)。两组治疗后的CD8^+水平差异无统计学意义(P>0.05)。结论高通量血液透析联合左卡尼汀改善尿毒症的疗效显著,其机制可能与纠正Th1/Th2之间平衡和细胞免疫紊乱有关。

Objective To observe the efficacy of the treatment of high-flux hemodialysis combined with L-carnitine on the immune function in patients with uremia. Methods 160 patients with uremia,from October 2014 to October 2015,were randomly divided into observation group and control group,80 cases in each group. The control group was performed high-flux dialysis,and observation group were given L-carnitine on the basis of the control group. Efficacy after treatment,the levels of blood urea nitrogen（BUN）,serum creatinine（SCr）,hemoglobin（Hbg）,albumin（Alb）,interleukin（IL）-2,IL-4,IL-10,interference（INF）-γ,CD3^＋,CD4^＋,CD8^＋and CD4^＋/CD8^＋before and after treatment were observed in each group. Results The total effective rate was 93. 75% in observation group,which is significantly higher than that of control group（81.25%）,the difference was statistically significant（P〈0.05）. The levels of BUN,Ccr,Scr,Hbg,Alb,IL-2,IL-4,IL-10,INF-γ,CD3^＋,CD4^＋,CD8^＋and CD4^＋/CD8^＋before treatment had no significant difference（P〉0.05）. The levels of BUN,Scr,IL-2,INF-γ and CD8^＋after treatment was significantly lower than those before treatment（P〈0.01） and the levels of Ccr,Hbg,Alb,IL-4,IL-10,CD3^＋,CD4^＋and CD4^＋/CD8^＋were significantly higher than those before treatment（P〈0.01）. The reduced or elevated levels were more obvious in observation group（P〈0.05）. The CD8^＋levels were no significant difference between two groups after treatment（P〉0.05）. Conclusion The efficacy of treatment of high-flux hemodialysis combined with L-carnitine in uremia patients were obvious,its mechanism may be related to the improvement of the Th1/Th2 balance and cellular immune disorder.