不同血液净化方式对慢性肾功能衰竭患者树突状细胞和血小板活化标志物表达的影响

Effects of different blood purification methods on the expression of dendritic cells and platelet activation markers in patients with chronic renal failure

目的比较血液透析(HD)、血液透析滤过(HDF)和血液灌流(HP)3种血液净化方式对慢性肾功能衰竭患者树突状细胞和血小板活化标志物表达的影响。方法选取2020年1—12月湖北省宜昌市第二人民医院肾内科收治慢性肾功能衰竭患者106例,按照随机数字表法分为HD组(n=36)、HDF组(n=35)、HP组(n=35),相应接受HD、HDF、HP治疗6个月,比较3组患者临床疗效,治疗前后相关生化指标、树突状细胞标志物、血小板活化标志物水平,以及并发症发生情况。结果HDF组、HP组总有效率高于HD组(χ^(2)/P=7.903/0.019),HDF组、HP组比较差异无统计学意义(P>0.05)。治疗6个月后HDF组、HP组血清白蛋白(Alb)、血红蛋白(Hb)水平均高于HD组,β_(2)-微球蛋白(β_(2)-MG)、瘦素(LEP)水平低于HD组(F=12.923、4.215、8.273、7.187,P均<0.001),而HDF组、HP组比较差异无统计学意义(P>0.05);3组治疗后BUN、SCr水平比较差异无统计学意义(P>0.05)。治疗6个月后HDF组、HP组CD1a、CD40、CD80、CD83、CD86高于HD组,血小板颗粒膜糖蛋白-140(GMP-140)、CD61、CD62P、CD63、P10低于HD组(F=122.973、82.255、51.985、21.987、52.707、23.717、43.744、57.373、28.594、51.562,P均<0.001),HDF组、HP组比较差异无统计学意义(P>0.05)。HDF组、HP组并发症总发生率低于HD组(χ^(2)/P=10.303/0.006),HP组、HDF组并发症总发生率差异无统计学意义(P>0.05)。结论HD、HDF、HP治疗慢性肾功能衰竭患者均具有一定效果,且HDF、HP疗效优于HD,可减少并发症,调节生化指标、树突状细胞标志物、血小板活化标志物水平,HDF与HP效果差异不明显,临床可视患者实际情况选择。

Objective To compare the effects of hemodialysis(HD),hemodiafiltration(HDF)and hemoperfusion(HP)on the expression of dendritic cells and platelet activation markers in patients with chronic renal failure.Methods A total of 106 patients with chronic renal failure admitted to the Department of Nephrology of the Second People's Hospital of Yichang City,Hubei Province from January to December 2020 were selected and divided into HD group(n=36),HDF group(n=35),HP group according to the random number table method Group(n=35),received HD,HDF,HP treatment for 6 months,and compared the clinical efficacy,related biochemical indicators,dendritic cell markers,platelet activation marker levels,and complications before and after treatment among the three groups.Results The total effective rate of HDF group and HP group was higher than that of HD group(χ^(2)/P=7.903/0.019),and there was no significant difference between HDF group and HP group(P>0.05).After treatment,the levels of serum albumin(Alb)and hemoglobin(Hb)in HDF group and HP group were higher than those in HD group,and the levels ofβ2 microglobulin(β2MG)and leptin(LEP)were lower than those in HD group(F=12.923,4.215,8.273,7.187,both P<0.001),but there was no significant difference between HDF group and HP group(P>0.05).There was no significant difference in the levels of BUN and SCr between the three groups after treatment(P>0.05).After treatment,CD1a,CD40,CD80,CD83,and CD86 in HDF group and HP group were higher than those in HD group,and platelet granule membrane glycoprotein 140(GMP140),CD61,CD62P,CD63,and P10 were lower than those in HD group(F=122.973,82.255,51.985,21.987,52.707,23.717,43.744,57.373,28.594,51.562,P<0.001),There was no significant difference between HDF group and HP group(P>0.05).The total incidence of complications in the HDF group and HP group was lower than that in the HD group(χ^(2)/P=10.303/0.006),and there was no significant difference in the total incidence of complications between the HP and HDF groups(P>0.05).Conclusion HD,HDF and HP all have certain effects in the treatment of patients with chronic renal failure,and the efficacy of HDF and HP is better than that of HD,which can reduce complications and regulate the levels of biochemical indicators,dendritic cell markers,and platelet activation markers.The difference in effect is not obvious,and the clinical selection can be based on the actual situation of the patient.