不同血液透析方案对维持性血液透析患者营养及微炎症状态的影响

Effects of different hemodialysis methods on nutrition and microinflammatory state of patients with maintenance hemodialysis

目的对比口服复方α-酮酸片行血液透析(HD)及血液透析滤过(HDF)与常规HD对维持性血液透析(MHD)患者营养及微炎症状态的影响。方法选取2010年9月至2016年6月在该院血液净化中心随访的MHD患者78例,将其分为A组(n=30)和B组(n=48)。A组口服复方α-酮酸片并行HD联合HDF,B组采取常规HD且未服用复方α-酮酸片。两组均治疗6个月。对比治疗前后两组患者简易营养评价表(MNA)评分、上臂肌围(MAMC)、血肌酐(Cr)、血清清蛋白(ALB)、血红蛋白,以及血清C-反应蛋白(CRP)及白介素-6(IL-6)水平。结果 A组患者治疗后MAMC、ALB、MNA评分均较治疗前显著增加,血清CRP、IL-6水平均明显下降,差异均有统计学意义(P<0.05)。B组患者治疗前后上述指标无明显变化。B组患者治疗后上述指标与A组治疗后比较,差异均有统计学意义(P<0.05)。结论 HD联合HDF及口服复方α-酮酸片的透析方案较常规HD未服用复方α-酮酸片的方案能明显改善MHD患者营养及微炎症状态。

Objective To compare the effect of hemodialysis（HD） combined with hemodialysis filtration（HDF） and compound α-keto acids tablets on nutrition and microinflammatory state of patients with maintenance hemodialysis（MHD） with conventional HD. Methods A total of 78 patients with MHD follow-up in blood purification center of Changshu No.2 People′ s Hospital from September 2010 to June 2016 were divided into two groups,group A（n=30） was treated with HD combined with HDF and compound α-keto acids tablets,group B（n=48） adopted conventional HD and not using compound α-keto acids tablets.Both groups were treated for six months.The mini nutritional assessment（MNA） score,mid arm muscle circumference（MAMC）,serum creatinine（Cr）,serum albumin（ALB）,hemoglobin and levels of C-reactive protein（CRP）,interleukin-6（IL-6）before and after treatment in the two groups were compared. Results The MAMC,ALB,MNA score were significantly increased,the serum CRP and IL-6 significantly decreased after treatment in group A,the differences were statistically significant（P〈0.05）. All above indices had no significant change before and after treatment in group B. All above indices after treatment in group B compared with those after treatment in group A,the differences were statistically significant（P〈0.05）.Conclusion HD combined with HDF and compound α-keto acids tablets can more significantly improve the nutrition and microinflammatory state of patients with MHD than conventional HD and not using compound α-keto acids tablets.