透析液微生物学质量提高对维持性血液透析患者营养和炎症状态的影响

Effects of microbiological improvement of dialysate on nutritional status and inflammatory parameters in maintenance hemodialysis patients

目的 探讨超纯水透析和循环管路构造改进对透析液微生物学质量及维持性血液透析(MHD)患者营养、炎症、氧化应激的影响。方法 对96例透析龄超过3个月的MHD患者进行为期6个月的随访,主要监测透析液微生物学质量、人体学指标、改良SGA评分、血生化指标、C反应蛋白(CRP)、血浆和红细胞膜丙二醛(MDA)、血浆总抗坏血酸(TAA)、还原型抗坏血酸(AA)、氧化型抗坏血酸(DHAA)、维生素E浓度、透析充分性(Kt/V)和蛋白分解代谢率(PCR)。结果 改进后6个月,透析液细菌数和内毒素水平明显下降(P<0.05);患者干体重、上臂肌围(MAMC)、血红蛋白(Hb)、白蛋白(AIb)、前白蛋白(PA)明显升高(P<0.05),改良SGA评分下降(P<0.01);CRP变化不明显(P>0.05);血浆维生素E、AA浓度增加,血浆DHAA/TAA下降(P<0.05),血浆MDA变化不明显,红细胞膜MDA则明显下降(P<0.05);Kt/V前后无明显变化;PCR值明显升高(P<0.05)。结论 改进透析液微生物学质量后,患者营养状态、体内氧化应激水平明显好转。

Objectives To improve the microbiological quality of dialysate and evaluated its effects on nutritional status and inflammation in maintenance hemodialysis(MHD) patients. Methods Ninety-six MHD patients were selected,who had undergone hemodialysis for at least three months before water quality improvement and were in a stable clinic status without signs of infection or disease activity,and finished the six-month follow-up. The parameters for microbiology,nutrition,inflammation and oxidative stress were measured. Results In the past six months,the average bacterial growth and the concentration of endotoxin decreased significantly (P < 0.05); dry weight,MAMC,Hb,Alb,PA increased while the score of modified SGA decreased markedly(P<0. 05); CRP level reduced after the improvement of dialysate but no statistical significance was found; the levels of ascorbic acid and vitamin E in plasma increased,while ratio of plasma dehydroascorbic acid to plasma total ascorbic acid decreased ( P < 0. 05). There was no difference in plasma malondialdehyde(MDA) between 6 months and baseline,whereas the level of MDA in erythrocytes dramatically dropped(P < 0.05); Kt/V kept stable(P> 0.05),but protein catabolic rate(PCR) rose significantly ( P < 0. 05). Conclusions The improvement of dialysate microbiological quality is effective,evidenced by better nutritional and oxidative stress status.