低通量和高通量透析膜对血液透析患者微炎症状态及促红细胞生成素低反应性的影响

Effect of low and high flux dialysis membranes on microinflammation status and erythropoietin low reactivity in patients with hemodialysis

目的对慢性肾脏病血液透析患者给予低通量及高通量透析膜治疗,旨在探讨其对患者体内微炎症状态及促红细胞生素(EPO)低反应性的影响。方法回顾性分析2020年3月至2022年5月在西安国际医学中心医院诊治的82例慢性肾脏病患者的临床资料,按照随机数字表法分为研究组与对照组,每组41例。对照组给予低通量透析治疗,研究组给予高通量透析治疗。对比两组患者肾功能指标、EPO用量、血细胞比容(Hct)、促红细胞生成素抵抗指数(ERI)及炎症因子水平,观察两组不良反应发生情况。结果干预后,两组患者甲状旁腺素(PTH)、血肌酐(Scr)及尿素氮(BUN)水平均较干预前明显降低(P<0.05),且研究组PTH、Scr及BUN水平均明显低于对照组(P<0.05)。干预后,研究组EPO用量及ERI较对照组明显降低(P<0.05),Hct较对照组明显升高(P<0.05)。干预后,研究组C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平较对照组明显降低,差异均有统计学意义(P<0.05)。Pearson相关性分析结果显示,慢性肾脏病血液透析患者ERI与PTH、Scr、BUN、CRP、TNF-α、IL-6水平均呈明显正相关(r=0.713、0.418、0.375、0.361、0.393、0.479,P<0.05)。研究组不良反应发生率为19.51%,明显低于对照组的43.90%,差异有统计学意义(P<0.05)。结论高通量透析膜可显著提高慢性肾脏病血液透析患者肾功能,改善患者体内微炎症状态,并减少EPO用量,有效改善EPO低反应性,且安全性较高,值得临床推广应用。

Objective To investigate the effects of low flux and high flux dialysis membranes on the microinflammation status and erythropoietin(EPO)low reactivity in hemodialysis patients with chronic kidney disease.Methods The clinical data in 82 patients with chronic kidney disease diagnosed and treated in Xi′an International Medical Center Hospital from March 2020 to May 2022 were retrospectively analyzed.The patients were randomly divided into the study group and control group according to the random number table method,41 cases in each group.The control group was given the low flux dialysis treatment and the study group was treated with the high flux dialysis.The renal function indexes,EPO dosage,hematocrit(Hct),erythropoietin resistance index(ERI)and inflammatory factors levels were compared between the two groups,and the adverse reactions in the two groups were observed.Results After intervention,the levels of parathyroid hormone(PTH),serum creatinine(Scr)and urea itrogen(BUN)in the two groups were significantly reduced compared with those before intervention(P<0.05),moreover the levels of PTH,Scr and BUN in the study group were significantly lower than those in the control group(P<0.05).After intervention,the EPO dosage and ERI in the study group were significantly decreased compared with those in the control group,and the Hct was significantly increased compared with the control group(P<0.05).After intervention,the C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)levels in the study group were significantly decreased compared with those in the control group,and the differences were statistically significant(P<0.05).The Pearson correlation analysis results showed that ERI in hemodialysis patients with chronic kidney disease had significantly positive correlation with PTH,Scr,BUN,CRP,TNF-αand IL-6 levels(r=0.713,0.418,0.375,0.361,0.393,0.479,P<0.05).The incidence rate of adverse reactions in the study group was 19.51%,which was significantly lower than 43.90%in the control group(P<0.05).Conclusion High flux dialysis membrane can significantly increase the renal function in hemodialysis patients with chronic kidney disease,improve the microinflammatory stat e in the patients,reduce the amount of EPO,effectively improve the low reactivity of EPO and has high safety,which is worthy of clinical promotion and application.