标题：血液透析联合血液灌流对尿毒症透析患者Hcy、hs-CRP、IL-6、TNF-α水平的影响

      作者：王 雅 1，章 茵 1，唐进攀 2
    (攀枝花市第二人民医院肾内科 1、检验科 2，四川 攀枝花 617068)

      卷次： 2014年25卷16期

      【摘要】 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 2 h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。

      【关键词】 尿毒症；血液透析；血流灌流；炎性因子

      【中图分类号】 R459.5 【文献标识码】 A 【文章编号】 1003—6350（2014）16—2401—03


Influence of hemodialysis combined with blood perfusion on the level of Hcy, hs-CRP, IL-6, TNF-α in patients
with uremia.
WANG Ya 1, ZHANG Yin 1, TANG Jin-pan 2. Department of Internal Medicine 1, Department of Clinical
Laboratory 2, the Second People's Hospital of Panzhihua, Panzhihua 617068, Sichuan, CHINA

【Abstract】 Objective To explore the influence of hemodialysis combined with blood perfusion on the level
of Hcy, hs -CRP, IL-6, TNF-α in 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-α in 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-α in ob-
servation group decreased significantly after treatment (All the P<0.05), however, the levels of hs-CRP, IL-6, TNF-α
in 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.