探讨尿毒症血液透析患者透析前后免疫指标及IL-6、CRP、IL-8、TNF-α的变化

Investigation of the immune parameters and IL-6,CRP,IL-8 and TNF-α changes in hemodialysis patients with uremia before and after hemodialysis

探究尿毒症血液透析患者透析前后免疫指标及IL-6、CRP、IL-8、TNF-α的变化。抽取2013年4月至2015年10月我院78例尿毒症患者,随机数表法分组,各39例。实验组采用高通量血液透析(high-flux hemodialysis,HFHD),对照组采用低通量血液透析(low-flux hemodialysis,LFHD),两组均观察治疗6个月。对比治疗前后两组免疫指标CIgA、IgG、IgM及其C3、C4)、红细胞免疫指标[红细胞免疫复合花环(erythrocyte immune complex rosette,RBC-ICR)、红细胞免疫抑制率(erythrocyte immunosuppressive rate,RFIR)、红细胞C3b受体(erythrocyte C3breceptor,RBC-C3bR)、红细胞免疫促进因子(erythrocyte immune promoting factor,RFER)]、血清炎性因子(IL-6、IL-8、CRP、TNF-α)及营养状态指标(PA、ALB、Hb)水平变化情况。(1)免疫指标:治疗后两组IgA、IgG、IgM、C3、C4等指标水平均较治疗前增高,且实验组IgA、IgG、IgM、C3、C4水平高于对照组,差异有统计学意义(P<0.05);(2)红细胞免疫指标:治疗后实验组RBC-ICR、RFIR水平低于对照组,RBC-C3bR、RFER水平高于对照组,差异有统计学意义(P<0.05);(3)血清炎性因子:治疗后两组IL-6、IL-8、TNF-α、CRP等指标水平均较治疗前降低,且实验组各指标低于对照组,差异有统计学意义(P<0.05);(4)营养状态:治疗后两组各指标水平均较治疗前增高,且实验组PA、ALB、Hb水平高于对照组,差异有统计学意义(P<0.05)。采用血液透析治疗尿毒症患者可有效降低血清炎性因子水平,改善免疫功能及营养状态,且HFHD效果优于LFHD。

To investigate the immune parameters and IL-6,CRP,IL-8 and TNF-αchange in patients with uremia before and after hemodialysis,from April 2013 to October 2015,78 patients with uremia collected were randomly divided into the study group and the control group,with 39 patients in each group.High-flux hemodialysis（HFHD）was carried out for patients of the study group,while low-flux hemodialysis（LFHD）for patients of the control group.Both groups were observed and treated for 6 months.Immune markers（IgA,IgG,IgM and C3,C4）,erythrocyte immune index[erythrocyte immune complex rosette（RBC-ICR）,erythrocyte immunosuppressive rate（RFIR）,erythrocyte C3 breceptor（RBC-C3 bR）,erythrocyte immune promoting factor（RFER）],serum inflammatory factors[IL-6,IL-8,C-reactive protein（CRP）,tumor necrosis factorα（TNF-α）]and nutritional status indicators[prealbumin（PA）,serum albumin（ALB）,hemoglobin（Hb）]levels were compared between the two groups before and after treatment.The results showed that（1）In both groups,levels of immunological parameters,e.g.,IgA,IgG,IgM,C3 and C4 were significantly reduced after hemodialysis,with the study group more prominent（P 0.05）;（2）At the end of the treatment,erythrocyte immune indicators in the study group were significantly lower than those in the control group,while the levels of RBC-C3 bR and RFER were significantly higher than those of the control group（P 0.05）;（3）Levels of serum inflammatory cytokines and CRP as well as other indicators in both groups were significantly reduced after hemodialysis,nevertheless,the indexes of the study group were lower than those of the control group,the difference was statistically significant（P 0.05）;（4）Nutritional status：The indexes of the two groups after treatment were significantly higher than those of before treatment,and the levels of PA,ALB and Hb in the study group were significantly higher than those in the control group（P 0.05）.These results indicate that hemodialysis in the treatment of uremic patients can effectively reduce the levels of serum inflammatory factors,improve immune function and nutritional status,and HFHD is more efficient than LFHD.