CAJ | 학술논문

目的探讨高通量血液透析对维持性血液透析(MHD)患者细胞免疫功能的影响.方法收集2012年3月至8月于本院门诊行MHD治疗的患者40例,随机数字表法分为血液透析(HD)组(n=20)和高通量血液透析(HFHD)组(n=20),分别接受HD和HFHD治疗,均为每周透析3次,每次4h.透析前、透析后4、24、48 h,流式细胞术检测两组患者外周血CD4+、CD8+、CD25+,记录CD4+/CD8+比值,酶联免疫吸附测定(ELISA)检测血清IL-2、可溶性IL-2受体(sIL-2R)；另设健康对照组(C组)20例,清晨空腹抽血检测上述指标.结果与C组比较,透析前HD组和HFHD组患者外周血CD4+、CD25+、CD4+/CD8+水平下降,血清IL-2水平下降,sIL-2R升高(均P＜0.05).与透析前比较,HD组患者透析后4h外周血CD4+、CD25+、CD4+/CD8+水平升高,血清IL-2水平升高,sIL-2R降低(均P＜0.05),CD8+差异无统计学意义(P＞0.05)；与透析前比较,HD组患者透析后24、48 h上述各指标差异无统计学意义(均P＞0.05).与透析前比较,HFHD组患者透析后4、24、48 h外周血CD4+、CD25+、CD4+/CD8+水平升高,血清IL-2水平升高,sIL-2R降低(均P＜0.05),而CD8+差异均无统计学意义(均P＞0.05).与同时点HD组比较,HFHD组透析后4h各指标差异均无统计学意义(均P＞0.05)；透析后24、48 h,HFHD组外周血CD4+、CD25+、CD4+/CD8+水平升高,血清IL-2水平升高,sIL-2R降低[CD4+:(38.73±6.25)％比(34.92±5.84)％,(37.03±5.41)％比(32.62±5.79)％; CD25+:(21.36±4.65)％比(15.29±4.72)％,(18.19±4.27)％比(13.94±5.05)％;CD4+/CD8+:1.42±0.31比1.23±0.29,1.38±0.30比1.20±0.33; IL-2:(22.03±5.18) mg/L比(19.03±4.87) mg/L,(20.54±5.92) mg/L比(18.26±4.96) mg/L; sIL-2R:(672.96± 159.36) U/ml比(787.32±143.27)U/ml,(720.24± 143.92) U/m1比(858.42±172.13)U/ml,均P＜0.05],而CD8+差异无统计学意义(均P＞0.05).结论 HD可短暂改善MHD患者的细胞免疫功能,HFHD可持续改善MHD患者的细胞免疫功能.
목적 탐토고통량혈액투석대유지성혈액투석(MHD)환자세포면역공능적영향.방법 수집2012년3월지8월우본원문진행MHD치료적환자40례,수궤수자표법분위혈액투석(HD)조(n=20)화고통량혈액투석(HFHD)조(n=20),분별접수HD화HFHD치료,균위매주투석3차,매차4h.투석전、투석후4、24、48 h,류식세포술검측량조환자외주혈CD4+、CD8+、CD25+,기록CD4+/CD8+비치,매련면역흡부측정(ELISA)검측혈청IL-2、가용성IL-2수체(sIL-2R)；령설건강대조조(C조)20례,청신공복추혈검측상술지표.결과 여C조비교,투석전HD조화HFHD조환자외주혈CD4+、CD25+、CD4+/CD8+수평하강,혈청IL-2수평하강,sIL-2R승고(균P＜0.05).여투석전비교,HD조환자투석후4h외주혈CD4+、CD25+、CD4+/CD8+수평승고,혈청IL-2수평승고,sIL-2R강저(균P＜0.05),CD8+차이무통계학의의(P＞0.05)；여투석전비교,HD조환자투석후24、48 h상술각지표차이무통계학의의(균P＞0.05).여투석전비교,HFHD조환자투석후4、24、48 h외주혈CD4+、CD25+、CD4+/CD8+수평승고,혈청IL-2수평승고,sIL-2R강저(균P＜0.05),이CD8+차이균무통계학의의(균P＞0.05).여동시점HD조비교,HFHD조투석후4h각지표차이균무통계학의의(균P＞0.05)；투석후24、48 h,HFHD조외주혈CD4+、CD25+、CD4+/CD8+수평승고,혈청IL-2수평승고,sIL-2R강저[CD4+:(38.73±6.25)％비(34.92±5.84)％,(37.03±5.41)％비(32.62±5.79)％; CD25+:(21.36±4.65)％비(15.29±4.72)％,(18.19±4.27)％비(13.94±5.05)％;CD4+/CD8+:1.42±0.31비1.23±0.29,1.38±0.30비1.20±0.33; IL-2:(22.03±5.18) mg/L비(19.03±4.87) mg/L,(20.54±5.92) mg/L비(18.26±4.96) mg/L; sIL-2R:(672.96± 159.36) U/ml비(787.32±143.27)U/ml,(720.24± 143.92) U/m1비(858.42±172.13)U/ml,균P＜0.05],이CD8+차이무통계학의의(균P＞0.05).결론 HD가단잠개선MHD환자적세포면역공능,HFHD가지속개선MHD환자적세포면역공능.
Objective To investigate the effect of high-flux hemodialysis on cellular immunity in patients receiving maintenance hemodialysis (MHD).Methods Forty outpatients in our hospital scheduled for MHD between March and August 2012 were recruited and assigned to be treated with hemodialysis (group HD,n=20) and high-flux hemodialysis (group HFHD,n=20) by random number table for 3 consecutive 4-hour courses per week.Peripheral blood CD4+,CD8+,CD25+ and CD4+/CD8+ ratio were assayed by flow cytometry,and the levels of serum IL-2 and sIL-2R were detected by enzyme-linked immunosorbent assay prior to and 4,24 and 48 h after dialysis.Twenty healthy subjects (group C) were subjected to the aforementioned measurements from the morning blood samples.Results Compared with group C,substantially lower levels of peripheral blood CD4+,CD25+,CD4+/CD8+ ratio and serum IL-2 yet higher levels of serum sIL-2R were noted in HD and HFHD group prior to MHD (all P＜0.05).Compared with the levels prior to MHD,4 h after hemodialysis in group HD resulted in increased level of peripheral blood CD4+,CD25+,CD4+/CD8+ ratio and serum IL-2 yet reduced serum sIL-2R (all P＜0.05),while the difference in CD8+ was unremarkable (P＞0.05).The difference in the aforementioned indices in group HD measured at 24 and 48 h after hemodialysis,as compared with those prior to MHD,was not statistically significant (all P＞0.05).Compared with the levels assayed prior to MHD,patients in group HFHD yielded markedly higher levels of peripheral blood CD4+,CD25+,CD4+/CD8+ ratio and serum IL-2 yet reduced levels of serum sIL-2R at 4,24 and 48 h after hemodialysis (all P＜0.05),while the difference in CD8+ was unremarkable (all P＞0.05).Group HD did not differ substantially with group HFHD in the aforementioned indices at 4 h after hemodialysis (all P＞0.05).Compared with group HD,group HFHD was characterized by considerably higher levels of peripheral blood CD4+,CD25+,CD4+/CD8+ ratio and serum IL-2 yet lower levels of serum sIL-2R [CD4+:(38.73±6.25)％ vs (34.92±5.84)％ at 24 h and (37.03±5.41)％ vs (32.62± 5.79)％ at 48 h after dialysis; CD25+:(21.36±4.65)％ vs (15.29±4.72)％ at 24 h and (18.19±4.27)％ vs (13.94±5.05)％ at 48 h after dialysis; CD4+/CD8+:1.42±0.31 vs 1.23±0.29 at 24 h and 1.38±0.30 vs 1.20± 0.33 at 48 h after dialysis; IL-2:(22.03±5.18)mg/L vs (19.03±4.87)mg/L at 24 h and (20.54±5.92)mg/L vs (18.26±4.96)mg/L at 48 h after dialysis; sIL-2R:(672.96±159.36)U/ml vs (787.32± 143.27)U/ml at 24 h and (720.24±143.92)U/ml vs (858.42±172.13)U/ml at 48 h after dialysis,all P＜0.05],while the CD8+ did not differ statistically at both time points (both P＞0.05).Conclusion HD may temporarily whilst HFHD may persistently improve cellular immunity in patients receiving MHD.