不同腹膜转运特性对CAPD患者细胞免疫功能与微炎症的影响

Influence of Different Peritoneal Transport Characteristics on Cellular Immunity and Microinflammation of CAPD Patients

目的:探讨腹膜转运特性对维持性腹膜透析(CAPD)患者细胞免疫功能及微炎症的影响。方法:选择CAPD患者120例,根据腹膜平衡试验(PET)分为高转运组和低转运组,检测患者血红蛋白(Hb)、尿素氮(BUN)、血肌酐(Scr)、血糖(Glu)、白蛋白(Alb)、三酰甘油(TG)、总胆固醇(TC)、CD4+、CD8+、CD4+/CD8+、CD25+(m IL-2R,膜白细胞介素-2受体)、白细胞介素-2(IL-2)、血清可溶性白介素-2受体(s IL-2R)、C反应蛋白(CPR)、肿瘤坏死因子α(TNF-α)的数值,同步计算PET值和尿素清除指数(Kt/V)、每周肌酐清除率(Ccr)。结果:高转运组每周Ccr明显高于低转运组,而Alb明显低于低转运组(P <0. 05)。高转运组的CD4+、CD4+/CD8+比值、m IL-2R、IL-2均低于低转运组,差异有统计学意义(P <0. 05)。血清s IL-2R、CRP、TNF-α在高转运组明显高于低转运组(P <0. 05)。血清Alb与D/Pcr值存在显著负相关,透析剂量和Ccr之间存在显著正相关,Alb和Ccr之间存在显著负相关(P均<0. 05)。CD4+、CD4+/CD8+比值、m IL-2R、IL-2与D/Pcr值呈显著负相关(P <0. 05),s IL-2R、CRP、TNF-α与D/Pcr值存在显著正相关(P <0. 05)。CD4+、CD4+/CD8+比值与m IL-2R、IL-2呈显著正相关,与s IL-2R、CRP、TNF-α呈显著负相关(P均<0. 05)。结论:CAPD高转运患者细胞免疫功能较低转运者差,而微炎症更严重。

Objective: To explore the influence of peritoneal transport characteristics on cellular immunity and microinflammation of contious ambulatory peritoneal dialysis(CAPD) patients. Methods: According to peritoneal equilibrium test(PET), 120 CAPD patients were divided into high transport group and low transport group. The clinical datas (Hb,BUN,Scr,Glu,Alb,TG,TC,CD 4 ^+,CD 8 ^+,CD 4 ^+/CD 8 ^+,CD 25 ^+(mIL-2R),IL-2,sIL-2R,CRP,TNF-α) were measured,meanwhile PET values and Kt/V were calculated synchronously. Results: Weekly Ccr, sIL-2R, CRP, TNF-α were significantly more in high transport group than those in low transport group( P <0.05), whereas Alb, CD 4 ^+、CD 4 ^+/CD 8 ^+ value、mIL-2R、IL-2 were lower in high transport group than those in low transport group( P <0.05). Pearson correlation analysis showed that D/Pcr values had a significant negative correlation with Alb, CD 4 ^+,CD 4 ^+/CD 8 ^+ values, mIL-2R,IL-2( P <0.05), and were positively correlated with sIL-2R, CRP, TNF-α( P <0.05). Furthermore, Ccr was positively correlated with dialysate dosage( P <0.05), and negatively correlated with Alb( P <0.05). Meanwhile, CD 4 ^+,CD 4 ^+/CD 8 ^+ values had a significant positive correlation with mIL-2R, IL-2( P <0.05), and were negatively correlated with sIL-2R, CRP, TNF-α( P <0.05). Conclusion: The cellular immunity and microinflammation of peritoneal high transport patients were worse as compared to low transport ones.