中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (04): 247-250.doi: 10.3969/j.issn.1671-4091.2017.04.008

• 临床研究 • 上一篇    下一篇

卧位体操对维持性血液透析患者毒素清除和炎症状态影响的研究

张兰1,程艳娇1,赵新菊2,甘良英2,左力2,马迎春1   

  1. 1 首都医科大学康复医学院，中国康复研究中心北京博爱医院肾内科
    2 北京大学人民医院肾内科
  • 收稿日期:2016-09-21 修回日期:2017-01-29 出版日期:2017-04-12 发布日期:2017-04-12
  • 通讯作者: 马迎春 mych323@163.com E-mail:mych323@163.com
  • 基金资助:

    中央级公益性科研院所基本科研业务费专项资金(2015CZ-38)

Effect of intradialytic physical exercise on toxin removal and inflammatory status in maintenance hemodialysis patients

  • Received:2016-09-21 Revised:2017-01-29 Online:2017-04-12 Published:2017-04-12

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摘要： 目的探讨血液透析中卧位体操运动对透析患者毒素清除及炎症状态的影响。方法选择中国康复研究中心北京博爱医院和北京大学人民医院肾内科血液透析超过3 个月的维持性血液透析(maintenance hemodialysis，MHD)患者103 例。随机分为运动组和对照组，运动组透析中进行卧位体操康复运动训练，每次20～40min，每周3 次，共24 周，观察运动组和对照组的毒素水平如尿素氮、肌酐、β2微球蛋白、全段甲状旁腺激素、瘦素以及炎症因子包括肿瘤坏死因子ɑ(tumor necrosis factor-a，TNF-α)、白介素1(interleukin-1，IL-1)、白介素6(interleukin-6，IL-6)等水平的变化。结果24 周后运动组和对照组比较，小分子、中分子和大分子毒素水平均无显著性变化(P＞0.05)；炎症因子，对照组IL-1(t=2.891，P=0.007)、TNF-α(t=2.813，P=0.009)明显下降，IL-6无明显变化；运动组IL-1、IL-6、TNF-α在
24 周运动前后无显著性差异(P＞0.05)。结论血液透析中卧位体操运动对小、中、大分子毒素清除无显著影响；透析中卧位体操运动对炎症因子清除影响不大，考虑与卧位体操运动时间短、运动强度低、整个研究时限不足相关。

关键词: 运动康复, 血液透析, 毒素, 炎症状态

Abstract: Objective To investigate the effect of intradialytic physical exercise on toxin removal and inflammatory status in maintenance hemodialysis (MHD) patients. Methods A total of 103 stable MHD patients treated in Peking University People's Hospital or Beijing Bo'ai Hospital of China Rehabilitation Research Center were enrolled in this study. They were randomly divided into control group and exercise group. Patients in the exercise group performed an intradialytic exercise program for 20～40min during the first 2 hours in a dialysis session, and the intradialytic exercise was carried out 3 dialysis sessions per week for 24 consecutive weeks. Urea nitrogen (BUN), creatinine (Scr), β2-microglobulin (β2-MG), intact parathyroid hormone (iPTH), leptin, and inflammatory cytokines including tumor necrosis factor alpha (TNF-α), interleukin 1 (IL-1), interleukin 6 (IL-6) were measured in both groups. Results The small molecular, middle molecular and macromolecular toxins, and serum leptin were not significantly changed (P＞0.05) in the exercise group as compared with those in the control group. In contro group after 24 weeks, serum IL-1 (t=2.891, P=0.007) and TNF-α (t=2.813, P=0.009) decreased significantly, and serum IL-6 remained. In excercise group after the intradialytic exercise for 24 weeks, serum IL-1, IL-6 and TNF-α had no significant changes. Conclusions Intradialytic physical exercise had no significant effects on the clearance of small, medium and large molecular toxins and inflammatory factors, probably due to the insufficient time and intensity of intradialytic exercise and the shorter observation period.

Key words: Exercise rehabilitation, Hemodialysis, Toxin, Inflammatory state