血液透析与血液滤过治疗对中性粒细胞碱性磷酸酶活性的影响

发布时间：2018-03-14 20:45

本文选题：血液透析　切入点：血液滤过　出处：《广西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的观察血液透析（HD）与血液滤过(HF)治疗过程中及治疗后对中性粒细胞碱性磷酸酶（NAP）活性及血肌酐（Scr）、血尿素氮（BUN）、尿酸（UA）、血磷（P3-）水平的影响，探讨血液透析与血液滤过两种治疗方式对中性粒细胞碱性磷酸酶（NAP）活性影响的可能机制。方法从2013年6月至2013年9月在广西医科大学第一附属医院血液净化中心治疗的符合条件的180名终末期肾病（ESRD）维持性透析患者中随机选取20人纳入本研究。采取前瞻性、交叉对比设计，将纳入本研究的20例维持性透析（MHD）患者随机分成两组，每组10例，每组包括男5例，女5例。第一阶段其中10例接受血液透析（HD）治疗，另10例接受血液滤过（HF）治疗；第二阶段予间隔3天后交叉替换透析方案。观察比较这两种血液净化方式治疗前、刚过滤器后、治疗结束后对中性粒细胞碱性磷酸酶（NAP）的活性及血肌酐（Scr）、血尿素氮（BUN）、尿酸（UA）、血磷（P3-）水平的影响。结果两种血液净化方式治疗前全血中性粒细胞碱性磷酸酶（NAP）积分均高于正常范围（与健康献血者比），刚过滤器后及治疗结束后均较治疗前NAP积分降低，，差异有统计学意义（P＜0.01），并可以恢复到正常水平。治疗过程中以刚过滤器后积分的下降率最为明显。血液滤过（HF）组治疗过程中NAP积分下降率均高于血液透析（HD）组，差异有统计学意义（P＜0.01）。两种血液净化方式治疗前血肌酐（Scr）、血尿素氮（BUN）、尿酸（UA）、血磷（P3-）水平均高于正常范围，刚过滤器后及治疗结束后均较治疗前Scr、BUN、UA、P3-水平降低，差异有统计学意义（P＜0.01）。血Scr、BUN、UA、P3-水平在治疗过程中均以刚过滤器后的下降率最为明显。血液透析（HD）组治疗过程中BUN、Scr、UA下降率均高于血液滤过（HF）组，差异有统计学意义（P＜0.01）。而两种血液净化方式治疗过程中血磷下降率差异均无统计学意义（P＞0.05）。血液透析（HD）组治疗时，NAP与BUN、UA的治疗前后下降率的变化呈正相关关系（P＜0.05），但其刚过滤器后较治疗前的下降率的变化无相关关系（P＞0.05）；NAP与Scr、P3-在整个治疗过程的下降率的变化无相关关系（P＞0.05）。血液滤过（HF）组治疗时，NAP与Scr、BUN、UA、P3-在整个治疗过程的下降率的变化均无相关关系（P＞0.05）。结论尿毒症患者可通过血液透析（HD）和血液滤过（HF）治疗有效的清除血肌酐（Scr）、血尿素氮（BUN）、尿酸（UA）、血磷（P3-）等毒素，而且血液透析（HD）治疗对Scr、BUN小分子毒素的清除效果比血液滤过（HF）治疗更佳。血液透析（HD）和血液滤过（HF）治疗均能将中性粒细胞碱性磷酸酶（NAP）积分降低至正常，提示血液透析（HD）和血液滤过（HF）治疗均能改善中性粒细胞碱性磷酸酶（NAP）的活性，且血液滤过（HF）比血液透析（HD）的作用更佳，血液滤过（HF）治疗在影响尿毒症患者免疫功能方面有着较明显的优势。血肌酐、血尿素氮等小分子毒素对中性粒细胞碱性磷酸酶活性的影响不明显。
[Abstract]:Objective to observe the effects of hemodialysis (HD) and hemofiltration (HFV) on the activity of neutrophil alkaline phosphatase (NAPs) and the levels of serum creatinine (SCR), bun (bun), uric acid (UAA) and phosphorus (P3) during and after treatment. To explore the possible mechanism of the effect of hemodialysis and hemofiltration on the activity of neutrophil alkaline phosphatase (NAPs). Methods from June 2013 to September 2013, 20 patients with maintenance dialysis of end-stage renal disease (ESRD) who were treated in the blood purification center of the first affiliated Hospital of Guangxi Medical University were enrolled in this study. Twenty patients with maintenance dialysis (MHD) were randomly divided into two groups: 10 patients in each group, including 5 males and 5 females. In the first stage, 10 patients were treated with hemodialysis with HDD. The other 10 patients were treated with hemofiltration (HFV), the second stage was treated with cross-replacement dialysis regimen after 3 days interval. The two blood purification methods were observed and compared before and after the treatment. The effects of treatment on the activity of neutrophil alkaline phosphatase (NAPs) and the levels of serum creatinine creatinine (SCR), blood urea nitrogen (bun), uric acid (UAA), and serum phosphorus (P 3) after treatment. Results the whole blood neutrophil alkaline phosphatase (NAP) scores were significantly higher than those of healthy blood donors before and after treatment (P < 0.01). The difference was statistically significant (P < 0.01) and could return to normal level. The decrease rate of NAP score in hemofiltration group was higher than that in hemodialysis group. The difference was statistically significant (P < 0.01). The levels of creatinine creatinine, bun (bun), uric acid (UAA) and phosphorus (P3-3) were higher than those in normal range before and after treatment, and the levels of Scr-BUNU UAP3- after treatment were lower than those before treatment. The difference was statistically significant (P < 0.01). The decrease rate of Scr-BUNUAUAP3- was the most obvious in the course of treatment. The decrease rate of BUN-Scr-UA in the HD group was higher than that in the hemofiltration group. The difference was statistically significant (P < 0.01), but there was no significant difference in the decrease rate of blood phosphorus between the two blood purification methods (P > 0.05). There was a positive correlation between the decrease rate of nap and Bun UA in the HD group before and after treatment (P < 0.05), but the difference was significant (P < 0.05). There was no correlation between NAP and ScrP3- during the whole course of treatment (P > 0.05). There was no correlation between nap and Scr-BUNUAP3- during the whole course of treatment in the hemofiltration group (P > 0.05), and there was no correlation between nap and Scr-BUNUAP3- during the whole course of treatment (P > 0.05). Conclusion the patients with uremia can be effectively treated with HD and HFV) in the treatment of serum creatinine cinnamon, blood urea nitrogen bun, uric acid UAA, blood phosphorus P3-and so on. In addition, HD) therapy was better than hemofiltration therapy in the clearance of Scr-bun small molecular toxin. Both hemodialysis and hemofiltration (HFH) treatment could reduce the score of neutrophil alkaline phosphatase (NAPs) to normal. The results suggest that both hemodialysis (HD) and hemofiltration (HFH) can improve the activity of neutrophil alkaline phosphatase (NAPs), and hemofiltration with HFD is better than hemodialysis. Hemofiltration therapy has obvious advantages in affecting immune function of uremic patients. The effects of blood creatinine, blood urea nitrogen and other small molecular toxins on the activity of neutrophil alkaline phosphatase are not obvious.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5

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