目的 观察常规血液透析(hemodialysis,HD)、高通量血液透析(high-flux hemodialysis, HFD)、血液灌流(hemoperfusion,HP)对终末期肾病(end-stage renal disease,ESRD)维持性血液透析(maintenance hemodialysis,MHD)患者微炎症状态的影响。 方法 选择广西百色市人民医院透析龄超过6个月的稳定MHD患者48例，随机分为HD组16例、HFD组16例和HD+HP组16例。3组患者分别在首次治疗前后，以及治疗3个月后透析前，通过免疫比浊法和酶联免疫吸附法(ELISA)测定患者C反应蛋白(C-reactive protein,CRP)、白细胞介素6(interleukin-6,IL-6)、肿瘤坏死因子 (tumor necrosis factor- ,TNF- )血清含量，同时测定20例健康志愿者CRP、IL-6、TNF 3组MHD患者共48例治疗前的CRP、IL-6、TNF(P＜0.001)，各组间差异无统计学意义(P＞0.05)。HD组首次治疗后及治疗3个月后CRP、IL-6、TNF (P＞0.05)。HFD组首次治疗后CRP、IL-6、TNF(P＞0.05)；治疗3个月后CRP下降，与治疗前比较差异无统计学意义(P＞0.05)，IL-6、TNF(P＜0.05)。HD+HP组首次治疗后CRP、IL-6、TNF RP与治疗前比较差异无统计学意义(P＞0.05)，IL-6、TNF(P＜0.05)；治疗3个月后，CRP、IL-6、TNF (P＜0.05)，但仍高于正常对照。治疗3个月后，HD+HP组的CRP、IL-6、TNF FD组，差异有统计学意义(P＜0.05)，HD+HP组下降百分比高于HFD组，差异有统计学意义(P＜0.01)。结论 MHD患者存在微炎症状态。HFD和HP可以降低CRP、IL-6、TNF, 改善患者的微炎症状态，HP可能优于HFD。3个月治疗并不能完全纠正微炎症状态，需进一步观察更长时间或联合其他治疗方法。
Objective To investigate the influence of regular hemodialysis (HD), high-flux hemodialysis (HFD) and hemoperfusion (HP) on microinflammatory state in ESRD patients on maintenance hemodialysis (MHD). Methods We enrolled 48 patients with MHD for more than 6 months in this hospital and divided them randomly into HD group (n=16), HFD group (n=16) and HD+HP group (n=16). Serum CRP, IL-6 and TNF-α were measured by immunoturbidimetry and ELISA in patients before and after the first dialysis session, and after the treatment for 3 months, as well as in 20 healthy volunteers as normal controls. Results (a) Serum CRP, IL-6 and TNF-α were significantly higher in the 3 groups of patients than in normal controls (P<0.001), but had no differences among the 3 groups of patients before the treatment (P >0.05). (b) In HD group, serum CRP, IL-6 and TNF-α increased after first dialysis session and after the treatment for 3 months, but the increases were statistically insignificantly (P>0.05). (c) In HFD group serum CRP, IL-6 and TNF-α decreased after the first dialysis session, but the decreases were statistically insignificant (P> 0.05). After the treatment for 3 months, however, serum IL-6 and TNF-α levels decreased significantly (P<0.05) without change of serum CRP level (P>0.05). (d) In HD+HP group, serum IL-6 and TNF-α decreased after the first dialysis session (P<0.05) without change of serum CRP (P >0.05). After the treatment for 3 months, serum CRP, IL-6 and TNF-α decreased (P<0.01), but were still higher than those of normal control group. (e) After the treatment for 3 months, serum CRP, IL-6 and TNF-α were significantly lower in HD+HP group than in HFD group, and the extent of the decreases was larger in HD+HP group than in HFD group. Conclusions (a) Microinflammation state exists in ESRD patients on MHD. (b) The lowering of patients’ serum CRP, IL-6 and TNF-α and thus the recovery from microinflammatory state can be achieved by HFD and HP, and preferably by HP. (c) Patients’ microinflammatory state can not radically corrected after 3 months treatment, therefore, other measures and longer period of follow-up must be conducted for these patients.
