高通量透析对维持性血液透析患者营养状况及牙周炎的影响

Effects of high-flux hemodialysis on nutrition status and prevalence of periodontitis in maintenance hemodialysis patients

背景:有研究显示,维持性血液透析患者的牙周炎患病率明显高于正常人群,因此如何改善维护性血液透析患者的营养不良及牙周状况受到众多学者的重视。目的:探讨高通量血液透析对维持性血液透析患者营养状况、微炎症状态及牙周炎患病率的影响。方法:将50例终末期肾脏疾病患者分2组进行维持性血液透析,试验组(n=25)进行高通量血液透析[超滤系数59 m L/(h·mm Hg),有效表面积1.8 m^2],对照组(n=25)进行低通量血液透析[超滤系数12 m L/(h·mm Hg),有效表面积1.4 m^2],两组均使用聚砜膜透析器材料。透析前及透析1年后,检测两组血清学指标,评估两组营养状况MQSGA评分(包括体质量改变、饮食情况、消化道症状、活动能力、合并症、脂肪消耗程度与肌肉消耗程度7项指标);透析1年后,检测两组牙周状况。结果与结论:(1)营养状况MQSGA评分:与透析前比较,试验组透析1年后的活动能力及肌肉消耗程度评分显著降低(P<0.05),其他指标无明显变化;对照组透析1年后的各指标无明显变化。试验组透析1年后的体质量、活动能力及肌肉消耗程度评分低于对照组(P<0.05);(2)血清学指标:与透析前比较,试验组透析1年后的血红蛋白、白蛋白、前白蛋白升高(P<0.05),高敏C-反应蛋白、三酰甘油、总胆固醇、全段甲状旁腺激素、血清β_2微球蛋白、血肌酐及尿素氮降低(P<0.05);对照组透析1年后的上述指标均无明显变化。试验组透析1年后的血蛋白、白蛋白、前白蛋白高于对照组(P<0.05),高敏C-反应蛋白、三酰甘油、总胆固醇、全段甲状旁腺激素、血清β_2微球蛋白低于对照组(P<0.05);(3)牙周状况:试验组牙周炎患病率低于对照组(P<0.05);(4)结果表明:高通量血液透析在改善维持性血液透析患者营养状况及微炎症状态的同时,有可能降低牙周炎的患病率。

BACKGROUND： Studies have shown that the prevalence of periodontitis is significantly higher in maintenance hemodialysis patients than the normal population. Therefore, how to improve the malnutrition and periodontal status of MHD patients has been an issue of concerns. OBJECTIVE： To explore the effects of high-flux hemodialysis on nutritional status, micro-inflammatory state and prevalence of periodontitis in maintenance hemodialysis patients. METHODS： Fifty patients with end-stage renal disease were divided into two groups for maintenance hemodialysis. The experimental group （n=25） was subjected to high-flux hemodialysis （ultrafiltration coefficient 59 mL/（h？mm Hg）, effective surface area 1.8 m2）. In the control group （n=25）, low-flux hemodialysis （ultrafiltration coefficient 12 mL/（h？mm Hg）, effective surface area 1.4 m2） was performed. Polysulfone membrane dialyzer was used in both groups. Serological indicators and scores on modified quantitative subjective global assessment （MQSGA） （including changes in body weight, diet, gastrointestinal symptoms, activity capacity, complications, degree of fat consumption and muscle consumption） to assess the nutritional status were tested in each group before dialysis and at 1 year of dialysis. Periodontal status of the two groups was examined at 1 year of dialysis. RESULTS AND CONCLUSION： （1） Nutritional status MQSGA score： compared with pre-dialysis, the activity ability and muscle consumption scores of the experimental group was significantly reduced at 1 year of dialysis （P 〈 0.05）, and the other indicators did not change significantly. In the control group, there were no significant changes in all the indicators at 1 year after dialysis. The scores of body weight, activity capacity and muscle consumption in the experimental group were significantly lower than those in the control group at 1 year of dialysis （P 〈 0.05）. （2） Serological indicators： Compared with the pre-dialysis, the hemoglobin, albumin and prealbumin levels in the experimental group were significantly increased at 1 year of dialysis （P 〈 0.05）, while high-sensitivity C-reactive protein, triglycerides, total cholesterol, intact parathyroid hormone, serum β2-microglobulin, serum creatinine and urea nitrogen levels decreased （P 〈 0.05）. The control group also had insignificant changes in the above indexes at 1 year of dialysis. The hemoglobin, albumin and prealbumin levels in the experimental group were significantly higher than those in the control group at 1 year of dialysis （P 〈 0.05）, and the levels of high-sensitivity C-reactive protein, triglyceride, total cholesterol, intact parathyroid hormone, serum β2-microglobulin was lower than those in the control group （P 〈 0.05）. （3） Periodontal status： The prevalence of periodontitis was lower in the experimental group than in the control group （P 〈 0.05）. These findings reveal that high-flux hemodialysis can improve the nutritional status and micro-inflammation state of maintenance hemodialysis patients, and it also effectively reduces the prevalence of periodontitis.