中国血液净化

›› 2006, Vol. 5 ›› Issue (4): 189-192.

• 论著 • 上一篇    下一篇

血液透析、微炎症对慢性肾衰竭患者呼吸功能的影响

苏海华 姜埃利 魏 芳 陈海燕 孙桂江   

  1. 300192 天津，天津医科大学第二医院血液净化中心(苏海华为研究生,工作单位天津渤海石油医院)
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2006-04-12 发布日期:2006-04-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2006-04-12 Published:2006-04-12

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摘要：

目的 探讨慢性肾衰竭患者呼吸功能改变及血液透析、微炎症对其影响。方法 选择天津医科大学第二医院血液净化中心42例慢性肾衰竭患者于透析前后分别进行肺功能测定，同时应用超敏C反应蛋白(hs-CRP)进行微炎症状态的评估，根据hs-CRP水平将患者分为2组，hs-CRP＞10mg/L为A组，hs- CRP＜10mg/L为B组,分别进行肺功能比较。 结果 慢性肾衰竭患者用力肺活量(FVC),1s用力呼气容积(FEV 1.0)，呼气流量峰值(PEF)，一氧化碳肺弥散量(DLco)，25%肺活量最大呼气流量(V 25)，50%肺活量最大呼气流量 (V50)以及呼吸肌功能指标最大吸气压(MIP)和最大呼气压(MEP)均明显低于健康志愿者( P＜0.01),其中A组患者FVC, FEV1.0, PEF, MIP, MEP低于B组(P＜0.01，P＜0.05)，而V 25、V50、DLco差异无显著性(P＞0.05)。Pearson相关分析显示hsCRP与FVC、FEV1.0 、PEF、MIP以及年龄、血清白蛋白(AlB)、血清肌酐(SCr)、血清转铁蛋白(STFR)明显相关( P＜0.01), 与MEP、血红蛋白(Hb)和前白蛋白(PA)相关( P＜0.05)，而与性别、透析疗程时间、V25 、V50、DLco无明显相关(P＞0.05)。血液透析后患者肺功能参数FVC、FEV1.0、PEF明显改善( P＜0.01)，V25、V50、DLco较透析前改善( P＜0.05)，而MIP、MEP透析前后无明显变化(P ＜0.05)。结论 慢性肾衰竭患者通气功能、弥散功能和小气道功能均明显下降，呼吸肌强度亦明显减弱，微炎症状态与通气功能和呼吸肌功能密切相关，血液透析可使部分呼吸功能损害明显改善。

关键词: 慢性肾衰竭, 血液透析, 微炎症状态, 肺功能

Abstract: Objective To explore the changes of respiratory function in patients with chronic renal failure and the effect of hemodialysis and microinflammatory on the impairments. Methods Fourty-two patients with chronic renal failure (CRF) who were on maintenance hemodialysis (MHD) received pulmonary function test (PFT) before and shortly after a hemodialysis (HD) session. At the same time, high-sensitivity C-reactive protein (hs-CRP) was measured to evaluate the microinflammatory state in CRF patients. CRF patients were divided into two groups Group A (hs-CRP＞10mg/L) and group B (hs-CRP＜10mg/L). The PFT parameters of the two groups were compared. Results The mean values of PFT parameters including FVC, FEV1.0, PEF, V25, V50, DLco, MIP, MEP in CRF patients were significantly lower than normal subjects (P＜0.01). The PFT parameters in group A including FVC, FEV1.0, PEF, MIP, MEP were significantly lower than those in group B (P ＜0.01, P ＜0.05).Whereas, there were no significant differences V25, V50 and DLco (P ＞0.05).There was significant correlation between hs-CRP and FVC, FEV1.0, PEF, MIP, age, serum albumin, serum creatinine，serum transferrin (P＜0.01), MEP, Hemoglobin, PA (P ＜0.05). Correlation analysis revealed no relationship between hs-CRP and Sex, Duration of HD, V25, V50, Dlco (P ＞0.05). After the HD session, repeat PFT revealed significant increase in FVC,FEV1.0, PEF, V25, V50, DLco, (P ＜0.01，P ＜0.05). But there were no significant difference of MIP,MEP. Conclusion Patients with CRF showed significant reductions in lung ventilation, pulmonary diffusing capacity and small airway function.The parameters about respiratory muscle strength decreased significantly. The function of ventilation and respiratory muscle are possibly associated with microinflammatory state. Hemodialysis can partly improve the impairment of respiratory function.

Key words: Hemodialysis, Microinflammatory state, Pulmonary function

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