不同血液净化方式

不同血液净化方式对尿毒症患者相关炎症因子及血清

脂蛋白-a的影响1

段海玲耿明亮崔向芹▲

山东省滨州市中心医院肾内科，山东滨州251700

摘要：目的通过对比观察不同血液净化方式治疗前后血清相关炎症因子、脂蛋白(a)[ Lipoprotein(a)LP(a)]的变化及其之间的相互关系，探讨不同血液净化方式对尿毒症患者相关炎症因子及血清LP(a)的影响。方法将75例初次透析的尿毒症患者随机分为血液透析（Hemodialysis HD）组及血液透析滤过（Hemodiafiltration HDF）组，分别测定治疗前及治疗后3个月血清C反应蛋白（C-reactive protein CRP）、肿瘤坏死因子-α（Tumor necrosis factor-αTNF-α）、白细胞介素-10（Interleukin-10 IL-10）、LP(a)浓度的变化。结果HD组治疗前后血CRP、TNF-a浓度及IL-10/TNF-a比较均无统计学差异(P>0.05)；HDF组治疗后血CRP、TNF-a浓度较治疗前及HD治疗后明显降低（P<0.01)，IL-10/TNF-a较治疗前明显升高（P<0.01)，与HD治疗后比较有所升高（P<0.05)。HD组治疗后血清LP(a)浓度较治疗前有所降低，但差异无统计学意义(P>0.05)，HDF组治疗后血清LP(a)浓度较治疗前及HD治疗后明显下降（P<0.01）。LP(a)与CRP 呈正相关（r=0.496），与IL-10/TNF-a比值呈负相关(r=-0.369)。结论血液透析滤过可以通过清除部分炎症因子，减轻微炎症状态，同时下调LP(a)水平，减少尿毒症患者相关并发症的发生发展。

关键词尿毒症；血液净化；C反应蛋白；肿瘤坏死因子-a；白细胞介素-10；脂蛋白（a）；

The influence of different blood purification methods on inflamm -atory factors and lipoprotein(a) in urinemia patients 【Abstract】Objective To observe the change and relationship between different blood purification methods on inflammatory factors

▲通讯作者

and lipoprotein(a) before and after the treatment. To observe the effects of different models of blood purification on microinflammatory stste、serum level inflammatory factors and Lipoprotein(a) in urinemia patients. Methods 75cases of uremic patients were divided into two groups randomly：hemodialysis (Hemodialysis HD) group, hemodiafiltration (Hemodiafiltration HDF) group. The plasma concentration of CRP、TNF-α、IL-10、Lipoprotein(a) were determined before and 3 month after treatment respectively. Results The level of CRP、TNF-α and IL-10 had no significant change before and after treatment in HD group，The level of CRP and TNF-α was significantly decreased after three month treatment in HDF group. Compared with HD group,CRP,TNF-a and IL-10 were significantly reduced after treatment in HDF group.There was not statistically significant in LP(a) concentration before and after treatment in HD group. The level of LP(a) was significantly decreased after treatment in HDF group, with significant difference between two groups.Lipoprotein(a) showed a positive relation with CRP, while a negative relaton were showed with IL-10/ TNF-α ratio.Conclusions Hemodiafiltration can treat urinemia patients effectively by eliminating certain inflamma tory factors, regulating microinflammatory state, decreasing serum Lipoprotein(a) level in certain degree.Therefore we can decreas the risk of complications and improve the prognosis of uremic patients.

Key words: uremia; blood purification; C-Reactive Protein; Tumor Necrotic Factor-a; Interleukin-10; Lipoprotein(a);

尿毒症不仅是肾功能进行性衰竭产生的一系列细胞、生化反应，而且还是以单核巨噬细胞系统激活及促炎症因子释放为中心的全身性轻微的慢性炎症状态，即“微炎症状态”[1]。尿毒症患者长期处于这种状态下，通过对不同部位的慢性炎症性损伤，最终引起营养不良、