不同透析方式对患者微炎症状态和营养状况的临床观察

发布时间：2018-05-14 16:54

本文选题：高通量血液透析 + 低通量血液透析　；参考：《新疆医科大学》2014年硕士论文

【摘要】：目的：探讨常规血液透析和高通量血液透析两种不同治疗析方式对维持性血液透析患者微炎症状态和营养状况的影响。方法：选取2011年7月至2012年11月在自治区人民医院血净中心长期固定的50例维持性血液透析患者,将入选患者随机分成两组,分别使用低通和高通两种不同的透析器进行透析。以3个月为观察周期,分别测定两组患者入组后首次透析(透析前)和治疗3个月后(透析前)的血浆白蛋白(Alb)、血红蛋白(HB)、肌酐(Cr)、尿素氮(BUN)、血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、β2微球蛋白(p2-GM)、甲状旁腺激素(PTH)的水平进行比较,同时进行主观综合性营养评估(subjective global assessment SGA),记录入组时和治疗3个月后的体重、体重指数、肱三头肌皮肤皱褶厚度(TSF)、上臂中段周径(MAC)和上臂中段肌肉周径(MAMC)。使用游标卡尺测量TSF用软尺测量MAC再计算MAMC。结果：CHD组与HFHD组首次透前各项指标比较无统计学差异(P0.05)；CHD组治疗3个月后对Cr、BUN、PTH、IL-6、CRP清除无统计学意义(P0.05),对Alb和Hb的影响无统计学意义(P0.05)；HFHD组治疗3个月后对BUN、Cr青除无差异(P0.05),对PTH、IL-6、CRP、β2-GM清除有统计学意义(P0.05),对Alb和Hb的提升有统计学意义(P0.05)；HFHD组与CHD组之间治疗3个月后对Cr、BUN清除无统计学意义(P0.05),对PTH、β2-GM、IL-6、CRP清除有统计学意义(P0.05),对Alb、Hb的提升有统计学意义(P0.05)。HFHD组治疗3个月后肱三头肌皮褶厚度、上臂中段周径测量值升高,有统计学意义(P0.05),两组治疗后对体重、BMI、MAMC的测量值无统计学意义。结论：高通量透析与常规低通量透析相比对PTH、β2-GM等大中分子毒素和IL-6和CRP等微炎症细胞因子的清除能力更显著,治疗效果优于常规透析。可以更有效降低长期透析病人的微炎症状态,并使营养不良状态得到一定改善,对MHD患者的预后有着重要意义。
[Abstract]:Objective: to investigate the effect of routine hemodialysis and high flux hemodialysis on microinflammation and nutritional status of maintenance hemodialysis patients. Methods: from July 2011 to November 2012, 50 patients with maintenance hemodialysis were selected from Xuejing Center of Autonomous region people's Hospital. The patients were randomly divided into two groups. The patients were dialyzed with two different dialyzers, low pass dialyzer and Qualcomm dialyzer. Take three months as the observation cycle, The plasma albumin Albbumin (AlbN), hemoglobin (HB), creatinine (Cr), bun (bun), serum C-reactive protein (CRP), interleukin-6 (IL-6), 尾 2 microglobulin (尾 2 microglobulin p2-GM) were measured in the two groups after first dialysis (before dialysis) and 3 months after treatment (before dialysis), respectively. The levels of parathyroid hormone (PTH) were compared. At the same time, subjective global assessment SGAA was used to record the body weight, body mass index, skin crease thickness of triceps brachii, circumference of middle arm of upper arm and peripheral diameter of muscle of middle arm of upper arm. Using Vernier caliper to measure TSF use soft ruler to measure MAC and calculate MAMCs. Results there was no significant difference in the indexes before the first dialysis between the HFHD group and the control group. There was no significant difference in the clearance of IL-6 and CRP between the two groups after 3 months of treatment. There was no significant difference in the effect on Alb and HB in the Alb and HB group after 3 months of treatment. There was no difference between the two groups after 3 months of treatment. There was significant difference in the clearance of Alb and HB. There was no significant difference in the clearance of CRP, 尾 2-GM and Cr bun after 3 months of treatment between CHD group and Alb group. There was a significant difference in the clearance of PTH, 尾 2-GMIL-6CRP and Albbumin HB. There was a statistical significance for the elevation of Albhib Hb in HFHD group and CHD group after 3 months of treatment, there was no significant difference in the clearance of CRP and 尾 -GMIL-6CRP, and there was a significant difference in the clearance of Alb and HB between HFHD group and CHD group after 3 months of treatment, there was no significant difference in the clearance of CRP and 尾 2-GMIL-6CRP. The skin fold thickness of triceps brachii muscle in HFHD group was 3 months after treatment. The measured value of circumference of midarm was higher than that of control group (P 0.05). There was no significant difference in the measurement of BMIM MAMC between the two groups after treatment. Conclusion: compared with conventional low-flux dialysis, high-throughput dialysis has better clearance ability of large and medium molecular toxins such as PTH, 尾 2-GM and microinflammatory cytokines such as IL-6 and CRP, and the therapeutic effect is better than that of routine dialysis. It is more effective to reduce microinflammation and improve malnutrition in long-term dialysis patients, which is of great significance to the prognosis of patients with MHD.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5

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