CAJ | 학술논문

目的：探讨维持性血液透析(MHD)患者超敏C反应蛋白(hs-CRP)水平与肺功能的关系。方法选取2011年1月~2013年12月广西壮族自治区梧州市人民医院收治的86例行MHD治疗的慢性肾功能不全患者作为血透组，并选择同期60例体检的正常成人作为对照组，比较两组透析前后的肺功能相关指标[6 min步行试验(6MWT)、肺活量(VC)、用力肺活量(FVC)、第1秒用力呼气量(FEV1)、FEV1/FVC、最大呼气中段平均流速(MMEF)、呼气峰值流速(PEF)]。采用免疫透射比浊法测定患者的hs-CRP水平，以hs-CRP≥3 g/L作为微炎症水平参考值，比较不同hs-CRP水平血液透析患者肺功能相关指标，并探讨血液透析患者hs-CRP水平与肺功能的关系。结果血透组透析前6MWT、VC、FVC、FEV1、FEV1/FVC、MMEF及PEF与对照组比较，差异有统计学意义(P<0.05或P<0.01)；血透组透析后6MWT、FEV1、FEV1/FVC、MMEF及PEF与对照组比较，差异有高度统计学意义(P<0.01)；血透组透析后6MWT、VC、FVC、FEV1、FEV1/FVC、MMEF及PEF与同组透析前比较，差异有高度统计学意义(P<0.01)。不同hs-CRP水平血液透析患者6MWT、VC、FVC、FEV1、FEV1/FVC、MMEF及PEF比较，差异有统计学意义(P<0.05或P<0.01)。血液透析患者hs-CRP水平与6MWT、VC、FVC、FEV1、FEV1/FVC、MMEF及PEF呈中等或强的负相关关系(P<0.05或P<0.01)。结论 MHD患者存在一定的微炎症状态，微炎症状态将给MHD患者的肺功能带来负面影响，临床医师在对患者进行血透时，应注重控制微炎症状态，以改善患者的肺功能状况。
목적：탐토유지성혈액투석(MHD)환자초민C반응단백(hs-CRP)수평여폐공능적관계。방법선취2011년1월~2013년12월엄서장족자치구오주시인민의원수치적86례행MHD치료적만성신공능불전환자작위혈투조，병선택동기60례체검적정상성인작위대조조，비교량조투석전후적폐공능상관지표[6 min보행시험(6MWT)、폐활량(VC)、용력폐활량(FVC)、제1초용력호기량(FEV1)、FEV1/FVC、최대호기중단평균류속(MMEF)、호기봉치류속(PEF)]。채용면역투사비탁법측정환자적hs-CRP수평，이hs-CRP≥3 g/L작위미염증수평삼고치，비교불동hs-CRP수평혈액투석환자폐공능상관지표，병탐토혈액투석환자hs-CRP수평여폐공능적관계。결과혈투조투석전6MWT、VC、FVC、FEV1、FEV1/FVC、MMEF급PEF여대조조비교，차이유통계학의의(P<0.05혹P<0.01)；혈투조투석후6MWT、FEV1、FEV1/FVC、MMEF급PEF여대조조비교，차이유고도통계학의의(P<0.01)；혈투조투석후6MWT、VC、FVC、FEV1、FEV1/FVC、MMEF급PEF여동조투석전비교，차이유고도통계학의의(P<0.01)。불동hs-CRP수평혈액투석환자6MWT、VC、FVC、FEV1、FEV1/FVC、MMEF급PEF비교，차이유통계학의의(P<0.05혹P<0.01)。혈액투석환자hs-CRP수평여6MWT、VC、FVC、FEV1、FEV1/FVC、MMEF급PEF정중등혹강적부상관관계(P<0.05혹P<0.01)。결론 MHD환자존재일정적미염증상태，미염증상태장급MHD환자적폐공능대래부면영향，림상의사재대환자진행혈투시，응주중공제미염증상태，이개선환자적폐공능상황。
Objective To explore relationship of high-sensitive C-reactive protein (hs-CRP) level and lung function in patients with maintenance hemodialysis (MHD). Methods 86 chronic renal insufficiency patients with MHD from Jan-uary 2012 to December 2013 in People’s Hospital of Wuzhou City in Guangxi Zhuang Autonomous Region were select-ed as hemodialysis group. 60 cases of normal adult in the same period were selected as control group. Pulmonary func-tion indexes [6 min walk test (6MWT), vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, average peak expiratory flow rate in the middle (MMEF), peak expiratory flow (PEF)] were com-pared before and after hemodialysis between two groups. Level of hs-CRP in patients with hemodialysis were detected by immunological transmission turbidimetry. hs-CRP ≥ 3 g/L as reference value of microinflammatory. Pulmonary function indexes in hemodialysis patients with different hs-CRP levels were compared. Relationship of hs-CRP level and pulmonary function in patients with hemodialysis was explored. Results 6MWT, VC, FVC, FEV1, FEV1/FVC, MMEF, PEF in hemodialysis group before hemodialysis and control group were compared, with statistical difference (P<0.05 or P<0.01). 6MWT, FEV1, FEV1/FVC, MMEF, PEF in hemodialysis group after hemodialysis and control group were compared, with significantly statistical difference (P<0.01). 6MWT, VC, FVC, FEV1, FEV1/FVC, MMEF, PEF in hemodialysis group after hemodialysis and same group before hemodialysis were compared, with significantly statistical difference (P<0.01). 6MWT, VC, FVC, FEV1, FEV1/FVC, MMEF, PEF in hemodialysis patients with different hs-CRP levels were compared, with statistical difference (P< 0.05 or P< 0.01). hs-CRP levels in hemodialysis patients had moderate or strong negative correlation with 6MWT, VC, FVC, FEV1, FEV1/FVC, MMEF, PEF (P< 0.05 or P< 0.01). Conclusion There are some micro-inflammatory state in MHD patients, micro-inflammatory state will adversely affect on lung function in MHD patients, clinicians should pay attention to control micro-inflammatory state when patients undergoing hemodialysis, so as to improve lung functional status of patients.