高通量血液透析对老年尿毒症患者营养、免疫及炎症状态的影响

Effects of high-flux hemodialysis on nutrition,immunity and inflammation in the elderly patients with uremia

目的探讨高通量血液透析(HFHD)对老年尿毒症患者营养状况、免疫指标及白细胞介素-6(IL-6)、IL-8、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)水平的影响。方法选取2014年1月至2017年12月北京航天总医院肾内科行血液透析的老年尿毒症患者112例,随机分为对照组(n=56)和观察组(n=56)。对照组采取常规的血液透析治疗,而观察组采取HFHD,均治疗6个月。分别于治疗前和治疗后6个月检测2组患者的血红蛋白(Hb)、血浆总蛋白(TP)、白蛋白(Alb)、前白蛋白(PA)、免疫球蛋白A(IgA)、IgM、IgG、C3、C4、血钙、血磷、甲状旁腺激素(PTH)、β_2-微球蛋白(β_2-MG)、IL-6、IL-8、TNF-α及CRP水平变化,分析2组患者治疗前后的营养状况、钙磷代谢、免疫指标及炎症状态。采用SPSS 22.0统计软件进行数据处理。根据数据类型,组间比较采用t检验或χ2检验。结果治疗后,观察组患者的Hb[(136.28±14.25)vs(98.53±12.26)g/L]、TP[(69.85±6.12)vs(62.37±5.50)g/L]、Alb[(37.92±3.80)vs(31.65±3.37)g/L]、PA[(312.70±63.28)vs(242.18±46.27)mg/L]、IgA[(1.97±0.43)vs(1.58±0.30)g/L]、IgM[(1.53±0.26)vs(1.16±0.18)g/L]、IgG[(10.92±2.17)vs(9.35±1.60)g/L]、C3[(1.26±0.18)vs(1.05±0.15)g/L]及C4[(0.82±0.11)vs(0.54±0.07)g/L]水平均显著高于对照组(P<0.05),而血磷[(1.84±0.31)vs(3.20±0.56)mmol/L]、PTH[(60.54±3.38)vs(107.43±7.56)mmol/L]、β_2-MG[(9.13±2.28)vs(20.82±3.27)mg/L]、IL-6[(197.42±40.63)vs(324.73±52.14)ng/L]、IL-8[(194.25±20.83)vs(237.15±28.60)ng/L]、TNF-α[(385.20±63.57)vs(468.37±71.40)ng/L]及CRP[(5.12±1.38)vs(6.30±1.54)mg/L]水平均显著低于对照组(P<0.05)。结论 HFHD可有效改善老年尿毒症患者的免疫功能及营养状态,且能降低血清炎性因子水平。

Objective To investigate the effects of high-flux hemodialysis （HFHD） on the nutrition, immunity, interleukin-6 （IL-6）, IL-8, tumor necrosis factor-α （TNF-α） and C-reactive protein （CRP） in the elderly patients with uremia. Methods Included in this study were 112 elderly patients with uremia treated in the Nephrology Department of Beijing Aerospace Hospital from January 2014 to December 2017. The patients were randomly divided into the control group （n=56） and the observation group （n=56）, the former receiving routine hemodialysis and the latter receiving high-flux hemodialysis treatment both for 6 months. Data of the two groups were collected before and at 6 month after the treatment, including hemoglobin （Hb）, plasma total protein （TP）, albumin （Alb）, prealbumin （PA）, IgA, IgM, IgG, C3, C4, blood calcium, blood phosphorus, parathyroid hormone （PTH）, β2-microglobulin （β2-MG）, IL-6, IL-8, TNF-α and CRP. Analysis of the two groups was made in the aspects of nutrition, calcium and phosphorus metabolism, immune indices and inflammation before and after treatment. SPSS statistics 22.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for comparison between two groups. Results The observation group had statistically significantly higher（P〈0.05） recordings than the control group after treatment in Hb [（136.28±14.25） vs（98.53±12.26）g/L], TP[（69.85±6.12） vs（62.37±5.50）g/L], Alb[（37.92±3.80） vs（31.65±3.37）g/L], PA[（312.70±63.28） vs（242.18±46.27）mg/L], IgA[（1.97±0.43） vs（1.58±0.30）g/L], IgM[（1.53±0.26） vs（1.16±0.18）g/L], IgG[（10.92±2.17） vs（9.35±1.60）g/L], C3[（1.26±0.18） vs（1.05±0.15）g/L], and C4[（0.82±0.11） vs（0.54±0.07）g/L], but significantly lower recordings （P〈0.05） in blood phosphorus[（1.84±0.31） vs（3.20±0.56）mmol/L], PTH[（60.54±3.38） vs（107.43±7.56）mmol/L], β2-MG[（9.13±2.28） vs（20.82±3.27）mg/L], IL-6[（197.42±40.63） vs（324.73±52.14）ng/L], IL-8[（194.25±20.83） vs（237.15±28.60）ng/L], TNF-α[（385.20±63.57） vs（468.37±71.40）ng/L] and CRP[（5.12±1.38） vs（6.30±1.54）mg/L]. Conclusion HFHD can effectively improve the immune function and nutritional status and reduce serum inflammatory factors in the elderly uremic patients.