目的 探讨不同血液净化方式对维持性血液透析(maintance hemodialysis,MHD)患者微炎性反应状态的影响。方法 选取在医院长期行血液透析的140例患者,随机分为血液透析组(hemodialysis,HD)、血液灌流组(hemoperfusion,HP)、高通量透析组(High-flow hemodialysis,HFD)、血液透析滤过组(hemodiafiltration,HDF),每组35例。通过不同血液净化方式治疗12个月,抽取静脉血检测每组患者治疗前后C反应蛋白(C-reactive protein,CRP)、白细胞介素6(interlerkin-6,IL-6)、肿瘤坏死因子α(tumornecrosis factorsα,TNF-α)、降钙素(procalcitonin,PCT)以及血肌酐(serum creatinine,SCR)、尿素氮(blood urea nitrogen,BUN )、β₂-微球蛋白(β₂-microglobulin,β₂-MG)、同型半胱氨酸(homocysteine,Hcy)、甲状旁腺激素(intact parathyroid hormone,iPTH)等指标水平,并进行对比分析。结果 CRP、IL-6、TNF-α、PCT炎性反应因子比较: HDF组、HFD组与治疗前比较水平升高,差异有统计学意义(P＜0.05);HFD组与HDF组比较差异无统计学意义,但与HD组、HP组对比水平升高,差异有统计学意义(P＜0.05)。iPTH、Hcy、β₂-MG尿毒症毒素比较: HP组、HDF组、HFD组与入组前比较显著下降,差异有统计学意义(P＜0.05);HDF组与HFD组两组间比较差异无统计学意义。但与HD组、HP组比较水平下降明显,差异有统计学意义(P＜0.05)。结论 HFD和HDP能充分清除MHD患者大中分子毒素,显著改善微炎性反应状态,且二者疗效没有差别。

Objective To compare the effects of different blood purification modalities on the micro-inflammatory status in maintenance hemodialysis(MHD) patients.Methods A total of 140 patients were equally randomized into four groups to receive 12-month blood purification treatment with hemodialysis (HD),hemoperfusion(HP), high-flow hemodialysis(HFD) and hemodiafiltration(HDF) respectively. Pre- and post-treatment serum concentrations of micro-inflammatory indexes including serum C-reactive protein(CRP),interlerkin-6(IL-6), tumornecrosis factors α(TNF-α), procalcitonin(PCT), serum creatinine(SCR), blood urea nitrogen(BUN), β₂-microglobulin(β₂-MG), homocysteine(Hcy) and intact parathyroid hormone(iPTH) were determined and compared.Results The levels of inflammatory response factors(CRP,IL-6, TNF-α and PCT) were significantly increased (P<0.05) after treatment, and were significantly higher in HDF and HFD groups than those in HD and HP groups(P<0.05), but no significant difference of the four indexes was found between the HFD group and the HDF group. The levels of uremic toxins(iPTH、Hcy、β₂-MG) after treatment were significantly reduced in HP,HDF and HFD groups (P<0.05), and were significantly lower in HP,HDF and HFD groups than those in the HD group(P<0.05).Moreover, the levels of iPTH、Hcy and β2-MG after treatment were significantly lower in HDF and HFD groups than those in the HP group(P<0.05), but no significant difference of these uremic toxins was found between the HFD group and the HDF group.Conclusions Both HFD and HDP can adequately eliminate large or moderate toxin molecules in patients with MHD and improve the micro-inflammatory status of uremic patients significantly, but no significant difference has been found between these two groups in terms of therapeutic effect.