腹膜透析与血液透析对尿毒症患者炎症细胞因子及钙磷代谢水平影响的对比研究

A comparative study of the effects of peritoneal dialysis and hemodialysis on inflammatory cytokines and calcium and phosphorus metabolism in uremic patients

目的比较腹膜透析与血液透析对尿毒症患者炎症细胞因子及钙磷代谢水平的影响。方法回顾性分析2014年7月至2016年7月北京市通州区新华医院肾内科收治的100例尿毒症患者的病例资料,以治疗方法将患者分为观察组和对照组,每组各50例。其中观察组患者为腹膜透析治疗,对照组患者为血液透析治疗。对比两组治疗前与治疗后(治疗6个月时)患者超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)水平变化,以及治疗后(治疗6个月时)钙、磷与甲状旁腺激素的代谢(低钙、高钙、低磷、高磷、低甲状旁腺激素与高甲状旁腺激素)情况与两组血钙、血磷、甲状旁腺激素水平情况。结果①治疗后观察组患者的hs-CRP(9.23±0.04)mg/ml、TNF-α(10.34±1.38)ng/ml与IL-6(13.38±2.93)ng/ml水平明显低于对照组(12.94±0.45)mg/ml、(13.48±2.97)ng/ml、(15.93±1.45)ng/ml,差异均具有统计学意义(P<0.05)。②观察组高磷的发生率22.0%低于对照组70.0%(P<0.05),低甲状旁腺激素发生率42.0%高于对照组16.0%(P<0.05),高甲状旁腺激素26.0%低于72.0%(P<0.05)。③观察组患者治疗6个月后的甲状旁腺激素水平(167.8±70.57)pg/ml低于对照组(187.2±68.23)pg/ml,血磷水平(1.33±0.94)mmol/L低于对照组(1.82±0.36)mmol/L,差异具有统计学意义(P<0.05)。结论腹膜透析相比较血液透析而言,能更为有效地清除hs-CRP、TNF-α与IL-6炎性因子,控制尿毒症患者的血钙、血磷代谢水平。

Objective To compare the effects of peritoneal dialysis and hemodialysis on inflammatory cytokines and calcium and phosphorus metabolism in uremic patients. Methods A retrospective analysis was performed in 100 cases of uremia admitted to the Department of Nephrology,Tongzhou District Xinhua Hospital from July 2014 to July 2016. The patients were divided into observation group and control group with 50 cases in each group. The patients in the observation group were treated with peritoneal dialysis,while those in the control group were treated with hemodialysis. The levels of hs-CRP (hypersensitive C-reactive protein,hs-CRP),TNF-α(tumor necrosis factor,TNF-α),IL-6 (interleukin 6,IL-6) and the metabolism of calcium,phosphorus and parathyroid hormone (low calcium,high calcium,low phosphorus,high phosphorus,low parathyroid hormone and high parathyroid hormone) before and after treatment (6 months) were compared between the two groups. The levels of serum calcium,phosphorus and parathyroid hormone in group A were compared. Results ①After treatment,the levels of hs-CRP(9.23±0.04)mg/ml,TNF-α(10.34±1.38)ng/ml and IL-6 (13.38±2.93) ng/ml in the observation group were significantly lower than those in the control group (12.94±0.45) mg/ml,(13.48±2.97) ng/ml,(15.93±1.45) ng/ml ( P < 0.05).②The incidence of high phosphorus in observation group was lower than control group 70.0%( P <0.05),the incidence of low parathyroid hormone was 42.0%( P <0.05) higher than 16.0%( P <0.05),and the incidence of high parathyroid hormone was 26.0%( P <0.05) lower than 72.0%( P <0.05).③6 months after treatment,the level of parathyroid hormone in the observation group (167.8±70.57) pg/ml was lower than that in the control group (187.2±68.23) pg/ml, and the level of blood phosphorus (1.33±0.94) mmol/L was lower than that in the control group (1.82±0.36) mmol/L ( P <0.05). Conclusion Compared with hemodialysis,peritoneal dialysis can more effectively remove hs-CRP,TNF-alpha and IL-6 inflammatory factors,and control the metabolic levels of serum calcium and phosphorus in uremic patients.