不同血液透析方式对维持性血液透析患者β2微球蛋白水平及微炎症状态的影响

Effect of different hemodialysis methods on the level of β 2-microglobulin and microinflammation in maintenance hemodialysis patients

目的探讨不同透析方式对血液透析患者体内β2微球蛋白(β2-microglobulin,β2-MG)清除作用及对微炎症状态的影响。方法将2016年6月-2017年6月本院透析患者138例分为三组,每周3次单纯血液透析组(HD);每周2次血液透析+1次血液滤过组,简称HDF组;每周2次血液透析+1次血液灌流组,简称HP组;于治疗前及治疗1年后,分别采集患者透析前血标本,测定β2微球蛋白及hs-CRP的水平,分析不同的透析方式对微炎症改善情况。结果 1.透析前三组β2微蛋白比较提示HD组低于HDF及HP组,而三组透析前hs-CRP、年龄、性别、透析龄、通路类型、血钙、血磷、PTH、KT/V等无统计学差异,三组基线一致。2.三组透析后β2微球蛋白均数比较:HD组较基线水平升高,其他两组均降低,且后两组降低幅度无差异性。三组超敏C反应蛋白(Hypersensitive C-reactive protein, hs-CRP)透析前后提示HD组有升高趋势,HP组较前减低,HDF组无明显改变,三组差值比较提示HP组降低幅度优于其他两组。结论血液透析联合血液滤过或血液灌流可有效降低β2微球蛋白、hs-CRP,抑制微炎症状态。

Objective To compare the effects of different dialysis methods on the clearance of β2-microglobulin and inflammatory in patients with maintenance hemodialysis. Methods 138 cases from June 2016 to June 2017 in our hospital patients with chronic kidney disease on hemodialysis were randomly divided into three groups,which were the conventional hemodialysis(HD)group, one hemoperfusion(HP)combined with twice hemodialysis(2 HD+1 HP), one hemodiafihratiothe(HDF)combined with twice hemodialysis(2 HD+1 HDF). continued treatment for 12 months,the pre-treatment and post-treatment of inflammatory factors,β2-microglobulin(β2-MG),Hypersensitive C-reactive protein,(hs-CRP)for comparison. Result 1. Comparison of β2-MG in the three groups before dialysis indicated that the HD group was lower than that of the HDF and HP groups, while hs-CRP, age, gender, dialysis age, access type,blood calcium, blood phosphorus, PTH, KT/V before dialysis showed no statistical difference among the three groups, and the baseline of the three groups was consistent. 2. Comparison of the mean of β2-MG in the three groups after dialysis: compared with the baseline level,the HD group increased, but the other two groups decreased, and the latter two groups showed no difference in the degree of reduction.Before and after hs-CRP dialysis in the three groups indicated an increasing trend in the HD group, a decrease in the HP group compared with before, and no significant change in the HDF group. Conclusion Hemodialysis combined with hemofiltration or hemoperfusion can effectively reduceβ2-MG 、hs-CRP,and inhibit the microinflammatory state.