以中心静脉导管和动静脉内瘘作为初始血管通路对于血液透析患者微炎症状态影响的研究

Study on the effect of central venous catheter and arteriovenous fistula as initial vascular access on the micro-inflammatory state of hemodialysis patients

目的探讨以中心静脉导管(CVC)和动静脉内瘘(AVF)作为初始血管通路对血透患者微炎症状态的影响。方法选择2018年5—11月本院收治的维持性血液透析(MHD)患者60例作为研究对象,根据患者初始血管通路的选择,将其分成CVC组和AVF组两组,每组各30例。分别在两组患者透析前及透析6个月、12个月后检测血清超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平,分析微炎症状态的变化。与此同时,取血清测定血红蛋白(Hb)、白蛋白(Alb)、总钙(Ca)、磷(P)、尿素氮(BUN)、肌酐(Cr)、尿酸(UA)以及全段甲状旁腺激素(PTH)含量。经Pearson线性相关分析hs-CRP、IL-6、TNF-α与各生化指标的相关性。结果在治疗6个月、12个月,CVC组血清hs-CRP、IL-6、TNF-α均显著高于治疗前以及AVF组(P<0.05)。CVC组治疗12个月的血清hs-CRP、IL-6、TNF-α均显著高于治疗6个月(P<0.05)。两组治疗后6个月、12个月的血清Hb、Alb均显著高于治疗前,其中CVC组显著低于AVF组(P<0.05)。两组血清UA、PTH含量均显著低于治疗前(P<0.05),两组血清Cr、BUN较治疗前比较无差异(P>0.05)。Pearson相关性分析提示血清hs-CRP、IL-6、TNF-α与血清Hb、Alb呈负相关(P<0.05)。结论初始通路为CVC更易引起透析患者微炎症状态,进而影响营养状态,故建议尽量减少CVC使用。

Objective To investigate the effect of central venous catheter(CVC)and arteriovenous fistula(AVF)as the initial vascular access on the micro-inflammatory state of hemodialysis patients.Methods 60 patients received maintenance hemodialysis(MHD)in our hospital from May 2018 to November 2018 were divided into CVC group(n=30)and AVF group(n=30)according to the choice of initial vascular access.The serum levels of Serum High sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6)and tumor necrosis factor-alpha(TNF-α)were measured before dialysis and 6 and 12 months after dialysis,respectively,and the changes of micro inflammation were analyzed.Meanwhile,hemoglobin(Hb),albumin(ALB),total calcium(Ca),phosphorus(P),blood urea nitrogen(BUN),creatinine(Cr),Uric Acid(UA),intact parathyroid hormone(PTH)were measured.The correlation of hs-CRP,IL-6,and TNF-αwith biochemical indexes was analyzed by Pearson linear correlation.Results At 6 th and 12 th month after treatment,the levels of hs-CRP,IL-6 and TNF-αin CVC group were significantly higher than those before treatment and those in AVF group(P<0.05).The levels of hs-CRP,IL-6 and TNF-αin CVC group at 12th month after treatment were significantly higher than those at 6 th month after treatment(P<0.05).At 6 th and 12 th month after treatment,the serum Hb and ALB of both two groups were significantly higher than those before treatment,and those of CVC group were significantly lower than those of AVF group(P<0.05).The contents of UA and PTH in the serum of the two groups were significantly lower than those before treatment(P<0.05),and there were no difference in Cr and BUN between the two groups compared with those before treatment(P>0.05).Pearson correlation analysis showed that serum hs-CRP,IL-6,TNF-αwere negatively correlated with serum Hb and ALB(P<0.05).Conclusions The initial pathway of CVC is more likely to cause micro-inflammation in dialysis patients,and then affect the nutritional status.Therefore,it is recommended to minimize the use of CVC.