血液透析滤过对尿毒症患者中性粒细胞吞噬功能的影响

Effect of hemodiafiltration on phagocytic function of neutrophils in uremia

目的探讨血液透析滤过对尿毒症患者中性粒细胞吞噬功能及酸碱、电解质的影响。方法选择尿毒症患者29例作为治疗组,接受高通量血液透析滤过(hign flux hemadiafileration,HFHDF)治疗。治疗组患者在维持性血液透析期间均接受1次HFHDF治疗,透析滤过过程中平均置换液流量为125~150 ml/min,置换液总量为30~40 L,透析超滤量为2.0~4.0 L,血流量为250~300 ml/min,透析液流量为500 ml/min,治疗时间4 h。所有接受透析治疗的患者其血管通路构建采用内瘘或颈内长期留置法留置导管,透析液为碳酸氢盐透析液,采用低分子肝素或普通肝素抗凝。观察治疗前后中性粒细胞吞噬率、吞噬指数、血尿素氮(BUN)、血肌酐(SCr)、白蛋白(albumin,Alb)、超敏C反应蛋白(highsensitivity C-reactive protein,hs-CRP)、β2-微球蛋白(β2-microglobulin,β2-MG)、电解质及二氧化碳结合力(carbon dioxide combining power,CO_2CP)。另选择体检健康的志愿者25例作为健康组,测定中性粒细胞吞噬率、吞噬指数。将尿毒症患者及健康组的血标本与白色葡萄球菌孵育30 min后,油镜下观察中性粒细胞吞噬白色葡萄球菌的情况,并计算中性粒细胞吞噬率、吞噬指数。其余项目送至我院检验科检测。结果尿毒症患者HFHDF治疗前中性粒细胞吞噬率、吞噬指数均低于健康组(P<0.05),治疗后中性粒细胞吞噬率高于健康组(P<0.05),而吞噬指数比较差异无统计学意义(P>0.05)。尿毒症患者HFHDF治疗后中性粒细胞吞噬率、吞噬指数及CO_2CP、补体C3均高于治疗前(均P<0.05),BUN、SCr、β_2-MG、K^+、P^-较治疗前下降,差异均有统计学意义(P<0.05),hs-CRP治疗前后比较差异无统计学意义(P>0.05)。结论尿毒症患者中性粒细胞吞噬功能低于健康人水平。HFHDF治疗能有效清除小分子和中分子物质,并纠正酸碱、电解质紊乱,提高尿毒症患者中性粒细胞的吞噬功能。

Objective To observe the effects of hemodiafiltration （HDF） on phagocytic function of neutrophils, acid-base and electrolyte in uremic patients. Methods Twenty-nine uremic patients and 25 normal controls for general health examination in our hospital physical examination center were en- rolled in this study. Uremic patients were treated with high flux hemodiafiltration once. In the process of HFHDF the average displacement liquid flow rate was 125 to 150 ml/min, the displacement liquid total of 30 to 40 L. The ultrafiltration volume was 2 to 4 L, with a blood flow of 350 to 400 ml/min and a dialysate flow of 500 to 600 ml/min, 4 hours per session. All patients receiving dialysis treat- ment were treated with fistula or long term indwelling catheter in the internal jugular vein, dialysate as bicarbonate dialysate, and low molecular weight heparin or unfractionated heparin was used for antico- agulation. Neutrophil phagocytic rate, neutrophil phagocytic index, blood urea nitrogen （BUN）, cre- atinine （SCr）, serum albumin, highsensitivity C-reactive protein （hs-CRP）, β2-microglobulin （MG）, serum kalium （K＋ ）, serum sodium, serum chlorine, serum calcium, serum phosphate （P-） and car- bon dioxide-combining power （CO2 CP） were detected in uremic patients pre- and post-HFHDF. Neu- trophil phagocytic rate, and phagocytic index were also assessed in control grouo. After 30 rain of in-cubation of blood samples of both uremic patients and health controls with Staphylococcus albus, neu- trophils were observed under a microscope, the neutrophil phagocytic rate and phagocytic index were calculated, and other items were tested in clinical laboratory of our hospital. Results Neutrophil phag- ocytic rate and phagocytic index of patients pre-HFHDF were lower than those of controls （P^0. 05）. Among 29 uremic patients, a significant increase of the neutrophil phagocytic rate was observed （P~ 0. 05）, while there was no statistically significant difference in neutrophil phagocytic index pre- and post-HFHDF （P^0. 05）. Neutrophil phagocytic rate, phagocytic index, CO2 CP and C3 of patients were significantly higher after the session, while the BUN, SCr, β2-MG, K＋ , and P- were signifi- cantly lower than those before （P〈0. 05）. No statistically significant difference was observed in the level of hs-CRP pre- and post-session （P〉O. 05）. Conclusions Phagocytic function of neutrophils is decreased in uremic patients. HFHDF can not only effectively remove uremic solutes, correct acid- base and electrolyte imbalance, but also enhance phagocytic capacity of neutrophils in uremic patients.