中国血液净化

›› 2011, Vol. 10 ›› Issue (3): 143-145.doi: 10.3969/j.issn.1671-4091.2011.03.00

• 临床研究 • 上一篇    下一篇

血液透析滤过对维持性血液透析合并心力衰竭患者微炎症和心功能的影响

The effect of hemodiafiltration on micro-inflammation and cardiac function in maintenance hemodialysis patients complicated with heart failure   

  1. 上海市利群医院肾内科
  • 收稿日期:2010-09-07 修回日期:1900-01-01 出版日期:2011-03-12 发布日期:2011-03-12

陶 英 薛 军 陈 烨

TAO Ying, XUE Jun, CHEN Ye   

  1. Department of Nephrology, Liqun Hospital, Shanghai 200333, China
  • Received:2010-09-07 Revised:1900-01-01 Online:2011-03-12 Published:2011-03-12

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摘要： 目的 观察血液透析滤过(hemodiafiltration,HDF)对维持性血液透析(hemodialysis,HD)合并心力衰竭患者微炎症和心功能的影响。 方法 选择上海市利群医院合并慢性充血性心力衰竭的维持性HD患者50例，随机分为HDF组25例和HD组25例，两组使用相同的药物治疗。两组患者分别在治疗前及治疗3个月后通过免疫比浊法和酶联免疫吸附法测定患者血清C反应蛋白(C-reactive protein,CRP)、白细胞介素6(interleukin-6,IL-6)和肿瘤坏死因子 (tumor necrosis factor- ,TNF- )含量，彩超测定左心室舒张末内径(left ventricular diastolic diameter,LVDd)、室间隔厚度(interventricular septal thickness,IVST)、左心室射血分数(left ventricular ejection fraction,LVEF)。并选择健康志愿者20例作为对照组。 结果 治疗前，HDF组与HD组的IL-6、CRP和TNF-崴较灾哂诙哉兆 (P＜0.01)，LVEDd明显扩大，IVST显著增厚，LVEF显著降低。治疗3个月后，HDF组和HD组的心力衰竭治疗有效率分别为92%和76%，两组差异有统计学意义(P＜O.05)；HDF组IL-6、CRP、TNF-崴浇现瘟魄敖档停钜煊型臣蒲б庖 (P＜O.05)，而HD组IL-6、CRP、TNF-崴浇现瘟魄安钜煳尥臣蒲б庖 (P＞0.05)；HDF组LVEF显著增高，LVEDd、IVST明显缩小，HD组LVEF较治疗前增高，但LVEDd、IVST改变不明显。 结论 合并心力衰竭的HD患者心脏功能严重受损，坚持长期HDF治疗可以有效清除中分子炎症介质，显著改善其心脏功能，提高治疗有效率。

关键词: 血液透析滤过, 微炎症, 心功能

Abstract: 【Abstract】 Objective To study the effect of hemodiafiltration on micro-inflammation and cardiac function in maintenance hemodialysis patients complicated with heart failure. Methods Fifty patients with uremic anemia and heart failure were divided into hemodiafiltration (HDF) group (n=25) and hemodialysis (HD) group (n=25). Patients in the 2 groups were treated with similar cardiotonic agents. Serum CRP, IL-6 and TNF-α were measured by immunoturbidimetry or ELISA method before the treatment and after treatment for 3 months. Their left ventricular diastolic diameter (LVDd), LVDs, interventricular septal thickness (IVST) and left ventricular ejection fraction (LVEF) were measured by echocardiogram. Result In HDF and HD groups before treatment, serum CRP, IL-6 and TNF-α were much higher than those in control group, the left ventricular end-diastolic dimension (LVEDd) and IVST increased, and the LVEF decreased remarkably (P<0.05). After the treatment, the significant amelioration rate and total effective rate were higher in HDF group than in HD group. Serum CRP, IL-6 and TNF-α decreased significantly in HDF group, but they were still higher in HD group. LVEF increased, and LVDd, LVDs and IVST decreased in HDF group, but these parameters unchanged in HD group after the treatment (P>0.05). Conclusion Cardiac function decreases apparently in hemodialysis patients complicated with heart failure. Long-term HDF removes inflammatory factors efficiently, improves cardiac function, and achieves a higher effective rate.

Key words: Micro-inflammation, Cardiac function