不同透析方式对血液透析患者炎性因子、内皮功能的影响

Effect of different dialysis methods on the inflammatory factors and endothelial function in hemodialysis patients

目的不同透析方式对血液透析患者血清炎性因子和血管内皮功能的影响。方法选取2017年6月~2018年12月杭州市富阳区第一人民医院血透室行维持性血液透析(MHD)患者44例。依据随机数字表法分为观察组和对照组,每组22例。观察组予每周2次普通血液透析(HD)治疗+1次血液透析滤过(HDF)治疗;对照组予每周3次普通HD治疗;治疗6个月。比较两组透析前和透析6个月后血清白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、血管性血友病因子(vWF)、可溶性细胞间黏附分子1(sICAM-1)水平,血清IL-6、hs-CRP水平与vWF、sICAM-l水平的相关性分析采用Pearson相关分析。结果两组透析前血清IL-6、hs-CRP水平比较,差异无统计学意义(P>0.05)。透析6个月后,对照组血清IL-6、hs-CRP与透析前比较,差异无统计学意义(P>0.05);观察组血清IL-6、hs-CRP水平低于透析前,且观察组低于对照组,差异均有统计学意义(均P<0.05)。两组透析前血清vWF、sICAM-1水平比较,差异均无统计学意义(P>0.05)。透析6个月后,对照组血清vWF、sICAM-1水平与透析前比较,差异无统计学意义(P>0.05);观察组血清vWF、sICAM-1水平均低于透析前,且观察组低于对照组,差异均有统计学意义(均P<0.05)。血清IL-6水平与vWF、sICAM-l水平呈正相关(r=0.463、0.457,P<0.05);血清hs-CRP水平与vWF、sICAM-l水平呈正相关(r=0.482、0.423,P<0.05)。结论与每周3次普通HD比较,每周2次普通HD+1次HDF可减轻MHD患者微炎症状态,降低血清vWF、sICAM-1水平,减少MHD患者血管内皮功能障碍及心血管疾病的发生。

Objective To observe the effect of different dialysis methods on the inflammatory factors and endothelial function in hemodialysis patients.Methods From June 2017 to December 2018,44 cases with maintenance hemodialysis(MHD)in the First People′s Hospital of Fuyang District were selected.According to the random number table method,they were divided into the observation group and the control group,with 22 cases in each group.The observation group was treated with ordinary hemodialysis(HD)2 times+hemodialysis filtration(HDF)1 time per week.The control group was treated with ordinary HD 3 times per week.Treatment for 6 months.Serum levels of interleukin-6(IL-6),hypersensitive C-reactive protein(hs-CRP),vascular willebrand factor(vWF)and soluble intercellular adhesion molecule 1(sICAM-1)were compared between the two groups before hemodialysis and 6 months after hemodialysis.Correlation analysis of serum IL-6 and hs-CRP levels with vWF and sICAM-1 levels was conducted by Pearson correlation analysis.Results There were no significant differences in serum levels of IL-6 and hs-CRP between the two groups before hemodialysis(P>0.05).Six months after hemodialysis,Serum IL-6 and hs-CRP in the control group showed no statistically significant differences compared with those before hemodialysis(P>0.05).Serum IL-6 and hs-CRP levels in the observation group were lower than those before hemodialysis,and those in the observation group were lower than the control group,with statistically significant differences(all P<0.05).There were no significant differences in serum levels of vWF and sICAM-1 between the two groups before hemodialysis(P>0.05).Six months after hemodialysis,serum vWF and sICAM-1 levels in the control group showed no statistically significant differ 0.05).The serum vWF and sICAM-1 levels in the observation group were lower than those before hemodialysis,and those in the observation group were lower than the control group,with statistically significant differences(all P<0.05).Serum IL-6 levels were positively correlated with vWF and sICAM-1 levels(r=0.463,0.457,P<0.05).Serum hs-CRP levels were positively correlated with vWF and sICAM-1 levels(r=0.482,0.423,P<0.05).Conclusion Compared with ordinary HD 3 times per week,ordinary HD 2 times+HDF 1 time per week can reduce the state of micro-inflammation in MHD patients,reduce the levels of serum vWF and sICAM-1,and reduce the occurrence of vascular endothelial dysfunction and cardiovascular disease in MHD patients.