不同血管通路对慢性肾衰竭患者透析效能、微炎症状态以及营养状态的影响

Effects of different vascular pathways on dialysis efficacy,microinflammatory status,and nutritional status in patients with chronic renal failure

目的:探究慢性肾衰竭(Chronic renal failure,CRF)患者采用带隧道带涤纶套透析导管(Tunneled-cuffed catheter,TCC)或自体动静脉内瘘(Autogenous arteriovenous fistulas,AVF)血管通路的血液透析效能及对其营养状态和微炎症状态的影响。方法:依据血管通路方式将我科2021年9月至2023年3月期间103例CRF患者分为2组,导管组51例患者采用TCC血管通路,内瘘组52例患者行AVF血管通路,均透析6 m后,采用酶联免疫法(Enzyme-linked immunosorbent assay,ELISA)测定白细胞介素-6(Interleukin-6,IL-6)、超敏C反应蛋白(Hypersensitive C-reactive protein,hs-CRP)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)水平,采用全自动生化分析仪测定血清铁蛋白水平、血清白蛋白、血红蛋白水平,并计算转铁蛋白饱和度,依据尿素氮清除率、尿素氮下降率评估其透析效能,并记录期间并发症发生情况。结果:内瘘组血管通路血流量、尿素氮清除率及尿素氮下降率均较导管组高;治疗后,内瘘组IL-6、hs-CRP、TNF-α较导管组低,转铁蛋白饱和度、血清铁蛋白血清白蛋白及血红蛋白水平均较导管组高,并发症内瘘组较导管组少(P<0.05)。结论:CRF患者透析采用AVF通路透析效能高于TCC通路,改善患者微炎症状态和贫血及营养状态效果显著优于TCC通路,且并发症较少。

Objective:To explore the hemodialysis efficacy of using a Tunneled Polyester Catheter(TCC)or Autologous Arteriovenous Fistula(AVF)vascular pathway in patients with chronic renal failure(CRF)and its impact on their nutritional and microinflammatory status.Methods:A total of 103 patients with CRF in our department from September 2021 to March 2023 were divided into two groups according to the way of vascular access.Fifty-one patients in the catheter group received TCC vascular access,and fifty-two patients in the internal fistula group received AVF vascular access.After 6 m dialysis,the levels of Interleukin-6(IL-6),hypersensitive C-reactive protein(hs-CRP),and tumor necrosis factor-α(TNF-α)were determined by Enzyme-linked immunosorbent assay(ELISA),serum albumin and hemoglobin were measured by the automatic biochemical analyzer,and the transferrin saturation level was calculated.The dialysis efficiency was evaluated based on the clearance rate and decreased rate of urea nitrogen,and the incidence of complications during the period was recorded.Results:The vascular pathway blood flow,urea nitrogen clearance rate,and urea nitrogen decrease rate in the fistula group were higher than those in the catheter group(P<0.05).After treatment,IL-6,hs-CRP,and TNF-αin the fistula group were significantly lower than in the catheter group,the transferrin saturation,serum ferritin,serum albumin,and hemoglobin levels were lower in the catheter group,and there were fewer complications in the fistula group(P<0.05).Conclusion:The dialysis efficiency of CRF patients using the AVF pathway is higher than that of the TCC pathway,and the effect of improving the patient's microinflammatory status,anemia,and nutritional status is significantly better than that of the TCC pathway,with fewer complications.