高通量血液透析对尿毒症患者炎症介质水平及代谢指标的影响

Effect of High Flux Hemodialysis on Inflammatory Mediators and Metabolic Indices in Patients with Uremia

目的:探讨高通量血液透析(HFHD)对尿毒症患者炎症介质水平及代谢指标的影响。方法:选择2018年8月—2020年8月在江西省九江市第一人民医院肾内科治疗的86例尿毒症患者作为研究对象,按随机数字表法将其分为两组,每组各43例。对照组采用血液透析滤过(HDF)+低通量血液透析(LFHD)治疗,观察组采用HFHD+LFHD治疗。比较两组患者炎症介质[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、代谢指标[全段甲状旁腺激素(iPTH)、血磷]及营养状态。结果:治疗前两组患者IL-6、TNF-α、iPTH及血磷水平对比,差异无统计学意义(P>0.05);治疗后观察组IL-6为(17.64±3.59)ng/L、TNF-α为(29.36±4.81)ng/L、iPTH为(486.36±50.79)ng/L及血磷为(1.64±0.28)mmol/L,低于对照组的(20.09±4.50)ng/L、(34.62±5.24)ng/L、(551.72±59.18)ng/L和(2.17±0.35)mmol/L,差异有统计学意义(t=2.791、4.849,P<0.05;t=5.496、7.754,P<0.05)。治疗前两组患者改良的定量主观整体评估法(MQSGA)评分及身体质量指数(BMI)对比,差异无统计学意义(P>0.05)。治疗后观察组MQSGA评分为(8.69±1.53)分,低于对照组,BMI为(24.96±1.12)kg/m^(2),高于对照组,差异有统计学意义(t=9.311、13.606,P<0.05)。结论:尿毒症患者采用HFHD治疗是安全有效的,能够清除炎症介质,改善患者代谢紊乱症状及营养状态,有助于促进患者病情的恢复。

Objective:To investigate the effect of high flux hemodialysis(HFHD)on the levels of inflammatory mediators and metabolic indices in uremia patients.Methods:A total of 86 patients with uremia treated in the hospital from August 2018 to August 2020 were selected and divided into two groups according to random number table method,with 43 cases in each group.The control group was treated with hemodiafiltration(HDF)+low flux hemodialysis(LFHD),and the observation group was treated with HFHD+LFHD.The inflammatory mediators(interleukin-6[IL-6],tumor necrosis factor-α[TNF-α]),metabolic indexes(whole parathyroid hormone[iPTH],blood phosphorus)and nutritional status were compared between the two groups.Results:There was no statistically significant difference in the levels of IL-6,TNF-α,iPTH and blood phosphorus between the two groups before treatment(P>0.05).After treatment,IL-6 in the observation group was(17.64±3.59)ng/L,TNF-αwas(29.36±4.81)ng/L,iPTH was(486.36±50.79)ng/L,and blood phosphorus was(1.64±0.28)mmol/L,lower than(20.09±4.50)ng/L,(34.62±5.24)ng/L,(551.72±59.18)ng/L,(2.17±0.35)mmol/L in the control group,the difference was statistically significant(t=2.791,4.849,P<0.05,t=5.496,7.754,P<0.05).Before treatment,there was no statistically significant difference between the two groups of modified quantitative subjective overall assessment(MQSGA)scores and body mass index(BMI)(P>0.05).After treatment,the MQSGA score of the observation group was(8.69±1.53)points,which was lower than that of the control group,and the BMI was(24.96±1.12)kg/m^(2),which was higher than that of the control group.The difference was statistically significant(t=9.311,13.606,P<0.05).Conclusion:HFHD treatment for patients with uremia is safe and effective.It can remove inflammatory mediators,improve the symptoms of metabolic disorders and nutritional status of patients,and help promote the recovery of patients.