CAJ | 학술논문

目的：探讨血液透析联合血液灌流对尿毒症透析患者同型半胱氨酸(Hcy)、高敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)水平的影响，以期能为改善尿毒症患者的微炎症状态提供参考。方法选取在我院行维持性血液透析的尿毒症患者50例为研究对象，按照数字表格法分为观察组与对照组各25例，对照组患者给予常规的血液透析治疗，每次4 h，每周3次，观察组采用血液透析联合血液灌流治疗，血液透析次数同对照组，血液灌流每周1次，在血液灌流2h后停止继续血液透析。观察治疗前、治疗后2个月时的Hcy、hs-CRP、IL-6、TNF-α、血红蛋白、血清白蛋白和前白蛋白水平。结果 Hcy、hs-CRP、IL-6、TNF-α治疗前观察组分别为(31.28±4.53)μmol/L、(12.78±8.17) mg/L、(23.54±9.46) ng/L、(90.07±32.73) ng/L，对照组分别为(32.87±4.20)μmol/L、(12.90±7.34) mg/L、(24.10±8.57) ng/L、(93.74±28.54) ng/L，两组比较差异均无统计学意义(P>0.05)；治疗后观察组的Hcy、hs-CRP、IL-6、TNF-α分别为(18.65±3.74)μmol/L、(8.89±2.03) mg/L、(28.65±4.49) ng/L、(113.60±21.44) ng/L，对照组为(34.11±3.58)μmol/L、(17.03±5.76) mg/L、(11.48±8.65) ng/L、(72.36±12.25) ng/L，观察组治疗后均较治疗前明显下降(P<0.05)，对照组治疗后hs-CRP、IL-6、TNF-α水平较治疗前有所升高(P<0.05)，治疗后Hcy、hs-CRP、IL-6、TNF-α水平观察组明显低于对照组(P<0.05)；观察组血红蛋白治疗后较治疗前升高(P<0.05)，亦高于对照组治疗后水平(P<0.05)。结论行血液透析的尿毒症患者明显存在微炎症状态及营养不良，联合血液灌流治疗能有效促使炎症因子Hcy、hs-CRP、IL-6、TNF-α的下降，并且改善营养状况。
목적：탐토혈액투석연합혈액관류대뇨독증투석환자동형반광안산(Hcy)、고민C반응단백(hs-CRP)、백세포개소-6(IL-6)、종류배사인자(TNF-α)수평적영향，이기능위개선뇨독증환자적미염증상태제공삼고。방법선취재아원행유지성혈액투석적뇨독증환자50례위연구대상，안조수자표격법분위관찰조여대조조각25례，대조조환자급여상규적혈액투석치료，매차4 h，매주3차，관찰조채용혈액투석연합혈액관류치료，혈액투석차수동대조조，혈액관류매주1차，재혈액관류2h후정지계속혈액투석。관찰치료전、치료후2개월시적Hcy、hs-CRP、IL-6、TNF-α、혈홍단백、혈청백단백화전백단백수평。결과 Hcy、hs-CRP、IL-6、TNF-α치료전관찰조분별위(31.28±4.53)μmol/L、(12.78±8.17) mg/L、(23.54±9.46) ng/L、(90.07±32.73) ng/L，대조조분별위(32.87±4.20)μmol/L、(12.90±7.34) mg/L、(24.10±8.57) ng/L、(93.74±28.54) ng/L，량조비교차이균무통계학의의(P>0.05)；치료후관찰조적Hcy、hs-CRP、IL-6、TNF-α분별위(18.65±3.74)μmol/L、(8.89±2.03) mg/L、(28.65±4.49) ng/L、(113.60±21.44) ng/L，대조조위(34.11±3.58)μmol/L、(17.03±5.76) mg/L、(11.48±8.65) ng/L、(72.36±12.25) ng/L，관찰조치료후균교치료전명현하강(P<0.05)，대조조치료후hs-CRP、IL-6、TNF-α수평교치료전유소승고(P<0.05)，치료후Hcy、hs-CRP、IL-6、TNF-α수평관찰조명현저우대조조(P<0.05)；관찰조혈홍단백치료후교치료전승고(P<0.05)，역고우대조조치료후수평(P<0.05)。결론행혈액투석적뇨독증환자명현존재미염증상태급영양불량，연합혈액관류치료능유효촉사염증인자Hcy、hs-CRP、IL-6、TNF-α적하강，병차개선영양상황。
Objective To explore the influence of hemodialysis combined with blood perfusion on the level of Hcy, hs-CRP, IL-6, TNF-αin patients with uremia. Methods Fifty cases with uremia were divided into observa-tion group (n=25) and the control group (n=25). Patients in control group were treated with regular hemodialysis, 4 h each time, three times once a week, and patients in observation group were treated with hemodialysis combined with blood perfusion. The blood perfusion was applied one time once a week, and regular hemodialysis was performed af-ter 2 h of hemoperfusion. The levels of Hcy, hs-CRP, IL-6, TNF-α, hemoglobin, serum albumin and pre- albumin were detected before and after 2 months treatment. Results The levels of Hcy, hs-CRP, IL-6, TNF-αin observation group and control group were (31.28 ± 4.53)μmol/L and (32.87 ± 4.20)μmol/L, (12.78 ± 8.17) mg/L and (12.90 ± 7.34) mg/L, (23.54 ± 9.46) ng/L and (24.10 ± 8.57) ng/L, (90.07 ± 32.73) ng/L and (93.74 ± 28.54) ng/L, respectively before treatment (All the P>0.05). However, the levels of Hcy, hs-CRP, IL-6, TNF-α in observation group and control group were (18.65±3.74)μmol/L and (34.11±3.58)μmol/L, (8.89±2.03) mg/L and (17.03±5.76)mg/L, (28.65±4.49) ng/L and (11.48±8.65) ng/L, (113.60±21.44) ng/L and (72.36±12.25) ng/L, respectively after treatment, with signifi-cant difference between two groups after treatment (All the P<0.05). The levels of Hcy, hs-CRP, IL-6, TNF-αin ob-servation group decreased significantly after treatment (All the P<0.05), however, the levels of hs-CRP, IL-6, TNF-αin control group increased significantly after treatment (All the P<0.05). The level of HGB after treatment was higher than that before treatment in observation group (P<0.05), and also higher that in control group after treatment (P<0.05). Conclusion Hemodialysis combined with blood perfusion can effectively remove inflammation factor Hcy, hs-CRP, IL-6, TNF-α, and improve the nutritional status.