血液灌流联合血液透析治疗对尿毒症患者肾性贫血、微炎症及氧化应激的影响

Influence of hemoperfusion combined with hemodialysis on renal anemia,micro-inflammatory state and oxidative stress in patients with uremia

目的:探讨血液灌流联合血液透析治疗对尿毒症患者肾性贫血、微炎症及氧化应激的影响。方法:回顾性分析2020年1月至2021年12月在芜湖市第五人民医院行维持性血液透析治疗的52例慢性肾衰竭患者的临床资料,将患者随机分为治疗组(行血液灌注联合血液透析治疗)和对照组(行单纯血液透析治疗),每组各26例。比较两组患者治疗前、后的血红蛋白(Hb)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、氧化产物丙二醛(MDA)及活性氧(ROS)水平。结果:治疗组患者治疗12周后的Hb水平较治疗前升高(t=8.23,P<0.001),并且高于对照组患者同期水平(t=7.89,P<0.001)。治疗组患者治疗后12周的TNF-α水平较基线时明显降低(t=15.48,P<0.001),明显低于对照组患者同期水平(t=19.16,P<0.001)。治疗组白介素-6(IL-6)水平较治疗前明显下降(t=14.08,P<0.001)。治疗12周后,治疗组患者的ROS水平较治疗前明显降低(t=21.79,P<0.001),明显低于对照组患者同期水平(t=22.90,P<0.001);治疗12周后,对照组患者的ROS水平较治疗前无明显改变(t=1.85,P=0.071)。治疗组的MDA水平较治疗前明显下降(t=20.16,P<0.001)。结论:血液灌流联合血液透析治疗可以更好地改善尿毒症患者贫血,使患者的Hb达标,这可能与血液灌流联合血液透析改善维持性血液透析患者微炎症及氧化应激状态有关。

Objective To investigate the hemoperfusion combined with hemodialysis on renal anemia,micro-inflammatory state and oxidative stress in patients with uremia.Methods The clinical data of 52 patients with chronic renal failure receiving maintenance hemodialysis treatment in the Fifth Peoples Hospital of Wuhu City from January 2020 to December 2021 were retrospectively analyzed,and the patients were randomly divided into treatment group(receiving hemoperfusion combined with hemodialysis treatment)and control group(receiving pure hemodialysis treatment),with 26 cases in each group.The levels of pre-treatment hemoglobin(Hb),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)and the oxidation products malondialdehyde(MDA)and reactive oxygen species(ROS)were compared.Results The Hb level of patients in the treatment group was higher than that before treatment(t=8.23,P<0.001),and was higher than that of patients in the control group during the same period,and the difference was statistically significant(t=7.89,P<0.001).The TNF-αlevel of patients in the treatment group was significantly lower than that at baseline(t=15.48,P<0.001),and was significantly lower than the level of patients in the control group during the same period(t=19.16,P<0.001).The level of IL-6 in the treatment group decreased significantly compared with that before treatment(t=14.08,P<0.001).The ROS level of patients in the treatment group after 12 weeks of treatment was significantly lower than that before treatment(t=21.79,P<0.001),which was significantly lower than the level of patients in the control group during the same period(t=22.90,P<0.001).The ROS level of patients in the control group was lower than that before treatment.The ROS levels of patients in the control group had no significant change compared with before treatment(t=1.85,P=0.071).The MDA level in the treatment group after 12 weeks of treatment was significantly lower than before treatment(t=20.16,P<0.001).Conclusions Hemoperfusion combined with hemodialysis treatment can better improve the anemia of uremia patients and make the patient's hemoglobin reach the standard,which may be related to the hemoperfusion series hemodialysis can reduce the microinflammation and oxidative stress status in maintenance hemodialysis patients.