高低通量血液透析对维持性血液透析患者微炎症、碱性磷酸酶水平和冠状动脉钙化的影响

Effects of high-or low-flux hemodialysis on microinflammation, alkaline phosphatase level and coronary calcification in maintenance hemodialysis patients

目的:探讨血液透析低通量与高通量模式对维持性血液透析(maintenance hemodialysis,MHD)患者炎症因子和碱性磷酸酶(alkaline phosphatase,ALP)水平以及冠状动脉钙化(coronary artery calcification,CAC)的影响。方法:100例MHD患者随机被分为低通量组(n=50)与高通量组(n=50),分别予以低通量透析模式和高通量透析模式。两组均每周进行3次透析,每次持续4 h,连续治疗6个月。比较两组血磷、血钙、全段甲状旁腺激素(intact parathyroid hormone,iPTH)、炎症因子[白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、 C反应蛋白(C-reactiveprotein, CRP)]、 CAC相关指标[冠状动脉钙化积分(coronaryarterycalcification score,CACS)、ALP]和并发症情况。结果:治疗后,高通量组血磷、i PTH均明显低于低通量组(均P<0.05),两组血钙水平对比差异无统计学意义(P>0.05)。治疗后,高通量组血清IL-6、TNF-α、CRP水平均显著低于低通量组(均P<0.05)。治疗后,两组CACS相比治疗前均增高(均P<0.05),但高通量组低于低通量组(P<0.05),并且高通量组血清ALP水平低于低通量组(P<0.05)。结论:高通量血液透析相比低通量血液透析能够有效地清除血磷、iPTH,改善微炎症状态,降低ALP水平,延缓CAC进程。

Objective: To investigate the effects of low and high flux hemodialysis models on inflammatory factors, and alkaline phosphatase(ALP) levels and coronary artery calcification(CAC) in maintenance hemodialysis(MHD) patients.Methods: A total of 100 MHD patients were randomly divided into a low-flux group(n=50) and a high-flux group(n=50), and they were treated with low-flux dialysis mode and high-flux dialysis mode, respectively. Both groups underwent dialysis for 4 hours 3 times a week. And the treatment lasted for 6 months. Blood phosphorus, blood calcium, intact parathyroid hormone(iPTH), inflammatory factors [interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), C-reactive protein(CRP)], CAC-related indicators [coronary artery calcification score(CACS), ALP] and complications were compared between the 2 groups.Results: After treatment, the levels of serum phosphorus and iPTH in the high-flux group were significantly lower than those in the low-flux group(both P<0.05), and there was no significant difference in blood calcium between the 2 groups(P>0.05). After treatment, the levels of serum IL-6, TNF-α, and CRP in the high-flux group were significantly lower than those in the low-flux group(all P<0.05). After treatment, the CACS scores of the 2 groups were higher than those before treatment(both P<0.05), but CACS scores in the high-flux group were lower than those of the low-flux group(P<0.05), and the serum ALP level of the high-flux group was lower than that of the low-flux group(P<0.05).Conclusion: Compared with low-flux hemodialysis, high-flux hemodialysis can effectively remove blood phosphorus and iPTH, improve microinflammatory state, reduce ALP level, and delay CAC process.