中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (10): 726-729.doi: 10.3969/j.issn.1671-4091.2023.10.002

• 临床研究 • 上一篇    下一篇

血液透析联合血液灌流对尿毒症患者血脂及微炎症状态的影响

张 宁   贺良玉    陶永媛    韩敬明    张艳萍    曹 宁   

  1. 110016沈阳，1中国人民解放军北部战区总医院血液净化科
    116000大连，2大连市第六人民医院血液净化中心
  • 收稿日期:2023-05-23 修回日期:2023-07-24 出版日期:2023-10-12 发布日期:2023-09-28
  • 通讯作者: 曹宁 E-mail:bzxyjhk@126.com

Effect of hemodialysis combined with hemoperfusion on blood lipids and micro inflammatory status in uremic patients

ZHANG Ning, HE Liang-yu, TAO Yong-yuan, HAN Jing-ming, ZHANG Yan-ping, CAO Ning   

  1. Department of Blood Purification, General Hospital of the Northern Theater Command of PLA, Shenyang 110016, China; 2Blood Purification Center, Dalian Sixth People's Hospital, Dalian 116000, China
  • Received:2023-05-23 Revised:2023-07-24 Online:2023-10-12 Published:2023-09-28
  • Contact: 110016 沈阳，1中国人民解放军北部战区总医院血液净化科 E-mail:bzxyjhk@126.com

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摘要： 目的 探讨血液透析(hemodialysis，HD)联合血液灌流(hemoperfusion，HP)对尿毒症患者血脂及微炎症状态的影响规律。 方法 选取2018年12月—2020年12月在北部战区总医院血液净化中心进行维持性血液透析治疗的尿毒症患者60例，通过随机数字表法将其分为对照组与试验组各30例。对照组患者进行常规的血液透析治疗，试验组患者在对照组的基础上联合血液灌流治疗，分别于治疗前和治疗12周后，采血观察治疗前后总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)以及肿瘤坏死因子α(TNF-α)水平的变化情况。 结果 对照组与试验组患者治疗前TC、TG、HDL-C、LDL-C水平间差异无统计学意义(t=1.582、0.488、0.096、0.908，P=0.119、0.627、0.924、0.368)；治疗12周后，试验组TC、TG、LDL-C水平低于对照组(t=2.101、4.308、2.521，P =0.040、＜0.001、0.014)，HDL-C水平高于对照组(t=3.408，P=0.001)；试验组治疗后TC、TG、 HDL-C、LDL-C水平改善优于对照组(t=3.709、2.108、2.336、3.401，P＜0.001、0.039、0.023、0.001)；治疗12周后2组患者CRP、IL-6、TNF-α水平与治疗前的组内比较均下降(t=3.062、2.694、4.575，P =0.003、0.009、＜0.001)；试验组CRP、IL-6、TNF-α水平改善显著优于对照组(t=8.574、7.698、9.256，均P＜0.001)。 结论 血液透析联合血液灌流可以有效改善尿毒症患者血脂代谢，同时可以较高效清除炎症因子，改善维持性血液透析患者的微炎症状态，存在推广价值。

关键词: 血液透析, 血液灌流, 血脂, 微炎症

Abstract: Objective  To investigate the effects of hemodialysis (HD) combined with hemoperfusion (HP) on blood lipids and micro inflammatory status in uremic patients.  Method  A total of 60 uremic patients undergoing maintenance hemodialysis at the Blood Purification Center of the Northern Theater Command General Hospital from December 2018 to December 2020 were recruited for this study. They were divided using a random number table method into a control group and an experiment group with 30 cases in each group. The patients in the control group received routine hemodialysis, while the patients in the experiment group received hemoperfusion in addition to hemodialysis in the control group. Before treatment and 12 weeks after the treatment, blood samples were collected to observe the changes of total cholesterol (TC), triacylglycerol (TG), high-density lipoprotein (HDL-C), low density lipoprotein cholesterol (LDL-C), C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α).  Result  There were no statistical differences in the levels of TC, TG, HDL-C and LDL-C before treatment between the two groups (t=1.582, 0.488, 0.096 and 0.908 respectively; P=0.119, 0.627, 0.924 and 0.368 respectively). After 12 weeks of treatment, the levels of TC, TG and LDL-C were lower in the experiment group than in the control group (t=2.101, 4.308 and 2.521 respectively; P=0.040, <0.001 and 0.014 respectively), while serum HDL-C was higher in the experiment group than in the control group (t=3.408, P=0.001); the improvement of TC, TG, HDL-C and LDL-C levels were better in the experiment group than in the control group (t=3.709, 2.108, 2.336 and 3.401 respectively; P<0.001, 0.039, 0.023 and 0.001 respectively); CRP, IL-6 and TNF-α decreased in both groups (t=3.062, 2.694 and 4.575 respectively; P=0.003, 0.009 and <0.001 respectively), but the levels of improvement were better in the experiment group than in the control group (t=8.574, 7.698 and 9.256 respectively; P<0.001).  Conclusion  The combination of hemodialysis and hemoperfusion can effectively improve the blood lipid metabolism, the clearance of inflammatory factors and the micro inflammatory state in maintenance hemodialysis patients. This method is worthwhile to be widely used clinically.

Key words: Hemodialysis, Hemoperfusion, Blood lipids, Micro inflammation

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