不同透析方式对尿毒症患者血管内皮细胞功能、微炎症状态及心血管并发症的影响

Vascular endothelial cell function, microinflammatory state and cardiovascular complications in uremic patients with different dialysis modalities

目的探讨尿毒症维持性血液透析(MHD)患者不同透析方式对血管内皮细胞功能、微炎症状态及心血管并发症的影响。方法选取尿毒症MHD患者60例,其中30例患者每周行2次高通量血液透析(HD)+1次血液透析滤过(HDF)治疗,为观察组;另30例患者每周行3次高通量HD治疗,为对照组。观察并比较两组患者治疗前(第1次透析治疗前)后(透析治疗1年后)血清炎症因子[包括超敏C反应蛋白(hs-CRP)、IL-6、TNF-α]和血管内皮细胞损伤因子[包括血管性血友病因子(vWF)、可溶性细胞间黏附分子1(sVCAM-l)]水平,以及治疗期间心血管并发症发生情况。结果治疗前,两组患者血清hs-CRP、IL-6、TNF-α、vWF、sVCAM-l水平比较差异均无统计学意义(均P>0.05);治疗后,两组患者以上5种因子均较治疗前降低(均P<0.05),且观察组均低于对照组(均P<0.05)。治疗期间,观察组患者心血管并发症发生率低于对照组(10.00%vs 30.00%,P<0.05)。结论与每周3次高通量HD比较,每周2次高通量HD+1次HDF的透析方式能更有效改善尿毒症MHD患者的血管内皮细胞功能,减轻微炎症反应,减少心血管并发症的发生。

Objective To investigate the effects of different dialysis modalities on vascular endothelial cell function,microinflammatory state and cardiovascular complications in uremic patients. Methods Sixty uremic patients undergoing maintenance hemodialysis(MHD)were enrolled in the study,including 30 cases receiving high-flux hemodialysis(HD)twice a week plus hemodialysis filtration(HDF)once a week(study group)and 30 cases receiving HD 3 times a week(control group).The serum inflammatory factors hs-CRP,IL-6,TNF-α,vascular endothelial cell damage factors von Willebrand Factor(vWF),and soluble vascular cell adhesion molecule-1(sVCAM-l))were measured and compared between two groups before and one year after treatment;and the incidence of cardiovascular complications during treatment was documented. Results Before treatment,there was of no significant difference in serum hs-CRP,IL-6,TNF-α,vWF,sVCAM-l between two groups(P>0.05).One year after treatment,serum hs-CRP,IL-6,TNF-α,vWF,sVCAM-l levels were decreased in both groups(P<0.05),while the above indicators in study group were all lower than those in the control group(P<0.05).During the treatment period,the incidence of cardiovascular complications in the study group was lower than that in the control group(10.00%vs 30.00%,P<0.05). Conclusion Compared with HD alone,the HD+HDF modality can more markedly improve the vascular endothelial cell function,reduce the microinflammatory response and decrease cardiovascular complications in uremic patients with MHD.