不同血液净化方式的尿毒症患者血清中毒素对单核细胞分泌炎性因子的影响

Clinical effect of the serum toxin in the inflammatory factors of the mononuclear cell secretion for uremia patients after the the different blood purification methods

目的观察不同血液净化方式治疗的尿毒症患者血清中毒素对单核细胞分泌炎性因子的影响。方法选取2014年2月-2015年3月收治的尿毒症患者60例,按照血液净化方式不同可划分为低通量血液透析(LFHD)组、高通量血液透析(HFHD)组、血液透析滤过(HDF)组,每组20例。3组患者经血液净化前后血清与单核细胞共同培养24 h后检测血清中C反应蛋白(CRP)、单核细胞趋化蛋白1(MCP-1)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)和肿瘤坏死因子-α(TNF-α)等指标水平。结果治疗前,3组CRP、MCP-1、IL-6、IL-8、TNF-α水平比较差异无统计学意义(P>0.05);LFHD组治疗后CRP、IL-6、TNF-α高于治疗前,MCP-1、IL-8低于治疗前,但差异均无统计学意义(P>0.05);HFHD组、HDF组治疗后CRP、MCP-1、IL-6、IL-8、TNF-α水平均低于治疗前,且HDF组降低幅度大于HFHD组,差异均有统计学意义(P<0.05)。结论 HFHD、HDF治疗后可有效抑制血清毒素及炎性因子,相较于LFHD方式效果较好。

Objective To observe the effects of serum toxic elements treated with different blood purification methods on the secretion of inflammatory factors in monocytes. Methods 60 uremia patients treated from February 2014 to March 2015 in the hospital were selected. The subjects were divided into LFHD group（ low flux hemodialysis） and HFHD group（ high flux hemodialysis） and HDF group（ hemodiafiltration）,with 20 cases in each group. After co culture of serum and mononuclear cells for 24 hours,the serum C reactive protein（ CRP）,monocyte chemotactic protein 1（ MCP-1）,interleukin 6（ IL-6）,interleukin 8（ IL-8） and tumor necrosis factor α（ TNF-α）. Results Before treatment,there was no significant difference in the levels of CRP,MCP-1,IL-6,IL-8 and TNF-α in the 3 groups（ P〉0. 05）. After treatment,the CRP,IL-6 and TNF-α in LFHD group were higher than before,MCP-1 and IL-8 in LFHD group were lower than those before treatment,but the differences were not statistically significant（ P〉0. 05）. After treatment,the levels of CRP,MCP-1,IL-6,IL-8 and TNF-α in HFHD group and HDF group were lower than those before treatment,and the decrease in HDF group was greater than that in HFHD group,the differences were statistically significant（ P〈0. 05）. Conclusion Compared with LFHD,the serum toxin and the inflammatory factors based on the HFHD and HDF were controlled in a better way.