高通量血液透析对维持性透析患者血清铁调素及低氧诱导因子的影响研究

Effect of high-flux hemodialysis on serum hepcidin and hypoxia-inducible factor in maintenance dialysis patients

目的观察高通量血液透析(high-flux hemodialysis,HFHD)对维持性血液透析(maintenance hemodialysis,MHD)患者血清铁调素(hepcidin)及低氧诱导因子(hypoxia inducible factor,HIF)的影响。方法将2018年5月~2020年4月在昆明市第一人民医院血液净化中心行低通量血液透析(low-flux hemodialysis,LFHD)治疗的60例MHD患者随机分为HFHD组和LFHD组,每组30例,2组患者均于试验开始时、试验6月、试验12月、试验18月采集透析前及透析后全血标本,检测并比较2组的血清铁调素、HIF、白细胞介素-6(IL-6)以及肿瘤坏死因子-α(TNF-α)的差异情况。结果试验18月时HFHD组患者铁调素水平低于LFHD组(Z=-2.927,P=0.003),HFHD组铁调素水平不同时间点比较有统计学差异(H=50.992,P<0.001),试验18月时最低。而低氧诱导因子在HFHD组和LFHD组间比较于试验开始时(Z=-1.442,P=0.149)、试验6月(Z=-1.952,P=0.051)、试验12月(Z=-0.834,P=0.404)、试验18月(Z=-3.152,P=0.912)无统计学差异,HFHD组和LFHD组内各时间点间比较结果均无统计学差异(H=13.212、6.369,P=0.808、0.095),且在时间上没有趋势性(Z=-0.933,P=0.351)。试验18月时,HFHD组的IL-6(Z=-1.996,P=0.046)及TNF-α(Z=-4.140,P<0.001)均低于LFHD组。结论HFHD和LFHD对HIF的影响均不大;与LFHD相比,HFHD能够降低MHD患者铁调素水平以及炎症因子IL-6和TNF-α水平;可能因高通量透析膜对血清铁调素及炎症因子的清除能力优于低通量透析膜;同时改善了患者体内的微炎症状态,从而降低了肝脏铁调素的高表达。

Objectives To investigate the effects of High-Flux Hemodialysis(HFHD)on Serum Hepcidin and Hypoxia Inducible Factor(HIF)in Maintenance Hemodialysis(MHD)Patients.Methods Sixty MHD patients in the First People’s Hospital of Kunming Blood Purification Center between May 2018 and April 2020 were randomly divided into the HFHD group and the Low Flux Hemodialysis(LFHD)group(30patients in each group).Pre-and post-dialysis whole blood specimens were collected from both groups at the beginning of the trial,6 months into the trial,12 months into the trial,and 18 months into the trial respectively.The differences in serum hepcidin,Hypoxia Inducible Factor(HIF),Interleukin-6(IL-6),and Tumor necrosis factor-α(TNF-α)were examined and compared between the two groups.Results The hepcidin level:(1)There was a statistically significant difference(Z=-2.927,P=0.003)between the HFHD group and the LFHD group[31.5(21.4,54.2)vs.49.1(36.9,68.8)]at 18 months.(2)There was a statistical difference of serum hepcidin at different time points in the HFHD group(H=50.992,P<0.001)and the lowest at 18 months.Hypoxia Inducible Factor(HIF):The results were not statistically different(P>0.05)between the HFHD and LFHD groups at each time point(Z=-1.442,-1.952,-0.834 and-3.152,P=0.149,0.051,0.404 and 0.912)or between different time points of the same group(H=13.212 and 6.369,P=0.808 and 0.095),and no significant trend over time was found.When compared between the two groups,IL-6 and TNF-αwere lower in the HFHD group than in the LFHD group at 18 months(Z=-1.996,P=0.046,Z=-4.140,P<0.001).Conclusion The effects of HFHD and LFHD on HIF were not significant.Compared with LFHD,HFHD decreased the levels of hepcidin,the levels of inflammatory factors IL-6 and TNF-αin patients with MHD which probably due to the preferential clearance of serum hepcidin and inflammatory factors by high-flux dialysis membranes,also improved the microinflammatory state in patients,thus reducing the high expression of hepcidin in the liver.