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目的探讨血液透析滤过(hemodiafiltration,HDF)联合血液灌流(hemoperfusion,HP)对维持性血液透析(maintaining hemodialysis,MHD)患者微炎症和营养不良状态的影响。方法选择2014年6月—2015年6月收治的MHD患者60例作为研究对象,随机分为血液透析(hemodialysis,HD)组和HDF+HP组各30例。HD组给予常规HD治疗,4 h/次,3次/周;HDF+HP组在HD组的基础上给予HDF串联HP治疗,1次/2周;两组均连续治疗24周。比较两组治疗前后IL-6、TNF-α、hs-CRP、Hcy水平,同时观察患者Hb、TP、Alb、TRF的变化情况。计量资料组间比较采用t检验,组内比较采用配对t检验,P<0.05为差异有统计学意义。结果 HDF+HP组治疗后hs-CRP、IL-6、TNF-α、Hcy分别为(5.75±2.11)、(51.10±7.65)、(81.21±8.41)ng/L、(12.31±2.21)μmol/L,均明显低于治疗前的(14.11±2.20)、(102.22±20.32)、(197.83±24.47)ng/L、(39.96±9.43)μmol/L,差异均有统计学意义(均P<0.05)。HDF+HP组治疗后Hb、TP、Alb、TRF分别为(105.65±22.21)、(63.10±22.65)、(39.21±6.41)g/L、(197.31±22.21)μg/L,均明显高于治疗前的(92.21±12.10)、(51.26±11.32)、(31.84±5.47)g/L、(162.96±15.42)μg/L,差异均有统计学意义(均P<0.05)。治疗后,HDF+HP组hs-CRP、IL-6、TNF-α、Hcy、Hb、TP、Alb、TRF与HD组[(13.32±1.20)、(96.68±25.65)、(101.32±24.24)ng/L、(38.23±8.34)μmol/L、(93.22±13.10)、(52.32±12.32)、(33.87±4.54)g/L、(163.23±15.33)μg/L]比较差异均有统计学意义(均P<0.05)。结论 HDF联合HP治疗MHD可明显改善患者体内微炎症及营养不良状态。
Objective To investigate the effect of hemodiafiltration (HDF) combined with hemoperfusion (HP) on the micro-inflammation and malnutrition in patients with maintenance hemodialysis (MHD). Methods Sixty patients with MHD admitted to our hospital from June 2014 to June 2015 were randomly divided into 30 patients in each of hemodialysis (HD) group and HDF + HP group. The patients in HD group were treated with HD, 4 h / time, 3 times / week. HDF + HP group was treated with HDF in series with HP on the basis of HD group once a week for two weeks. The levels of IL-6, TNF-α, hs-CRP and Hcy before and after treatment were compared. The changes of Hb, TP, Alb and TRF were also observed. Measurement data were compared between groups using t test, the group was compared using paired t test, P <0.05 for the difference was statistically significant. Results The levels of hs-CRP, IL-6, TNF-α and Hcy were (5.75 ± 2.11), (51.10 ± 7.65), (81.21 ± 8.41) ng / L and (12.31 ± 2.21) μmol / L were significantly lower than those before treatment (14.11 ± 2.20), (102.22 ± 20.32), (197.83 ± 24.47) ng / L and (39.96 ± 9.43) μmol / L, respectively ). The levels of Hb, TP, Alb and TRF were (105.65 ± 22.21), (63.10 ± 22.65), (39.21 ± 6.41) g / L and (197.31 ± 22.21) μg / L in HDF + HP group (92.21 ± 12.10), (51.26 ± 11.32), (31.84 ± 5.47) g / L and (162.96 ± 15.42) μg / L, respectively. There were significant differences between the two groups (all P <0.05). The levels of hs-CRP, IL-6, TNF-α, Hcy, Hb, TP, Alb, TRF and HD in HDF + HP group were significantly higher than those in HD group [(13.32 ± 1.20), (96.68 ± 25.65) and (101.32 ± 24.24 (38.23 ± 8.34) μmol / L, (93.22 ± 13.10), (52.32 ± 12.32), (33.87 ± 4.54) g / L, (163.23 ± 15.33) μg / L] were statistically significant All P <0.05). Conclusions HDF combined with HP can significantly improve the microinflammatory and malnutrition status in patients with MHD.