血液透析过程中微炎症状态的评估及黄芪注射液对其影响

Assessment on microinflammatory state in hemodialysis process and effects of Huangqi Injection

目的:探讨维持性血液透析(MHD)患者的微炎症状态及透析过程中滴注黄芪注射液对其影响。方法:入选54例维持性血液透析患者,检测人体学测量、血生化、透析充分性(e Kt/V)及C-反应蛋白(CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)等微炎症指标;观察血透过程中予以黄芪注射液滴注维持后血清微炎症指标的变化,以及微炎症指标与血脂、营养状况的相关性。结果:(1)MHD患者高CRP者31例(占57.4%),且高CRP者的年龄、三酰甘油、TNF-α较正常者高,白蛋白、高密度脂蛋白较正常者低(P<0.05)。(2)CRP与体质量指数、三酰甘油、低密度脂蛋白呈正相关(P<0.05),与高密度脂蛋白、e Kt/V呈负相关(P<0.05);TNF-α与白蛋白呈负相关(P<0.05)。多元回归分析显示,三酰甘油是影响CRP的独立危险因素,白蛋白、血红蛋白是影响TNF-α的独立危险因素。(3)常规透析后CRP较透析前明显升高(P<0.05),IL-6较透析前明显降低(P<0.05);TNF-α较透析前升高,但差异无统计学意义。(4)应用黄芪注射液后,透析前后CRP、IL-6差值较未用药时明显减少(P<0.05);TNF-α差值减少,但差异无统计学意义。结论:MHD患者中微炎症状态与蛋白质-能量营养不良、脂代谢紊乱及透析充分性相关,其中三酰甘油、白蛋白、血红蛋白是影响微炎症状态的独立危险因素;透析过程能加重微炎症状态,滴注黄芪注射液能部分改善透析过程中的微炎症状态。

Objective: To discuss the microinflammatory state in patients with maintenance hemodialysis( MHD) and the effects of Huangqi Injection drip on it. Methods: 54 MHD patients were enrolled in this research. The anthropometric measurements,blood biochemical parameters,dialysis adequacy( e Kt/V),and microinflammatory indicators including C-reactive protein( CRP),interleukin-6( IL-6) and tumor necrosis factor-α( TNF-α) were detected. During the hemodialysis,the changes of serum microinflammatory indicators were observed after instillation maintenance of Huangqi Injection,and the correlation between microinflammation indicators and blood lipid and nutritional status were analyzed. Results:(1)31 cases of MHD patients( accounted for 57. 4%) showed high level of CRP,and the age,triacylglycerol( TG) and TNF-α of patients with high level of CRP were higher than those of normal people,the levels of albumin( ALB) and high density lipoprotein( HDL) were lower than those of normal people( P<0.05).(2)CRP was positively correlated with body mass index,TG and low density lipoprotein( P < 0. 05),and negatively correlated with HDL and e Kt/V( P < 0. 05); TNF-α was negatively correlated with ALB( P<0.05). Multivariate regression analysis showed that TG was an independent risk factor for CRP,while albumin and hemoglobin were independent risk factors for TNF-α.(3)After routine dialysis,the level of CRP was significantly increased compared with pre-dialysis( P<0.05),and the level of IL-6 was obviously decreased( P<0.05). The level of TNF-α was increased after dialysis,but with no statistically significance.(4)After treatment with Huangqi Injection,compared with no medication,the D-values of CRP and IL-6 levels between dialysis before and after were significantly decreased( P<0.05),and the D-value of TNF-α level between dialysis before and after was decreased with no statistically significance. Conclusion: Microinflammatory status in MHD patients is associated with protein-energy malnutrition,lipid metabolism disorders and dialysis adequacy. Among them,triacylglycerol,albumin and hemoglobin are independent risk factors for microinflammatory state. Dialysis can aggravate the state of microinflammation. Huangqi Injection drip can partly improve the microinflammatory state during dialysis.