不同血液净化模式对终末期肾病患者的自身免疫、炎症应激及生活质量的影响

发布时间：2019-03-18 20:29

【摘要】：目的探讨在不同血液净化模式下,患者体内免疫细胞、炎症因子、生存质量变化情况及与其之间的关系。方法采用便利抽样法,选取2015年6月-2016年6月在该院肾内科血液净化中心的终末期肾病(ESRD)患者138例。其中82例为血液透析(HD)组,39例为高通量血液透析(HFHD)组,17例为血液透析滤过(HDF)组。血液净化6个月前后,采用流式细胞仪、细胞生物法、酶联免疫吸附法检测3组患者的免疫细胞(CD4~+,CD8~+,CD25~+,CD4~+/CD8~+)百分比、C-反应蛋白(CRP)、可溶性白细胞介素2受体(s IL-2R)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)血清含量及生存质量(SF-36)评分,比较血液净化前后自身及各组间的变化。结果血液净化6个月后,3组患者体内免疫细胞、炎症因子除CD8~+、TNF-α外,其余免疫细胞(CD4~+,CD25~+,CD4~+/CD8~+)含量、炎症因子(CRP、s IL-2R、IL-6)水平及生存质量各维度评分及总评分比较,差异有统计学意义(P0.05);与HD组相比,HDF组、HFHD组患者体内免疫细胞含量升高、炎症因子水平降低、生存质量各维度评分及总评分升高;其中HFHD组患者体内免疫细胞含量及生存质量各维度评分和总评分升高幅度最大,与HDF组比较,差异有统计学意义,HDF组患者体内炎症因子下降幅度最大,与HFHD组相比,差异无统计学意义。3组患者免疫细胞含量、炎症因子水平、生存质量各维度评分及总评分自身前后比较,除HD组自身前后差别无统计学意义外,其余两组HDF组、HFHD组患者自身前后比较均差异有统计学意义(P0.05)。相关分析显示:免疫细胞、炎症因子与HD组患者生存质量评分无关;HFHD组和HDF组免疫细胞除CD8~+外,其余与其生存质量呈正相关,炎症因子除TNF-α外,其余与其生存质量呈负相关。结论 HDF、HFHD均可升高患者体内免疫细胞含量,降低炎症因子水平,提高患者生存质量,以HFHD效果较佳。
[Abstract]:Objective to investigate the changes of immune cells, inflammatory factors and quality of life (QOL) in patients with different blood purification modes and their relationship with the changes in immune cells, inflammatory factors and quality of life (QOL). Methods from June 2015 to June 2016, 138 patients with end-stage nephrotic disease (ESRD) were selected from June 2015 to June 2016 in the blood purification center of the Department of Nephrology. Among them, 82 cases were hemodialysis (HD) group, 39 cases were high flux hemodialysis (HFHD) group, and 17 cases were hemodiafiltration (HDF) group. After 6 months of blood purification, the percentage of immune cells (CD4~, CD8~, CD25~, CD4~ / CD8~) and C-reactive protein (CRP), were detected by flow cytometry, cell biology and enzyme linked immunosorbent assay (Elisa). Serum levels of soluble interleukin 2 receptor (s IL-2R), interleukin 6 (IL-6), tumor necrosis factor 伪 (TNF- 伪) and quality of life (SF-36) were compared before and after blood purification. Results after 6 months of blood purification, the contents of CD4~, CD25~, CD4~ / CD8~ and the inflammatory factors (CRP,s IL-2R,), except for CD8~ and TNF- 伪, were detected in the immune cells of the three groups. IL-6) level and quality of life (QOL) scores and total scores, the difference was statistically significant (P0.05); Compared with HD group, in HDF group and HFHD group, the content of immune cells increased, the level of inflammatory factors decreased, and the scores of all dimensions and total scores of QOL increased. The scores and total scores of immune cell content and quality of life in HFHD group were significantly higher than those in HDF group. The decrease of inflammatory factors in HDF group was the highest compared with that in HFHD group, and there was no significant difference between HDF group and HFHD group, but there was no significant difference between HDF group and HFHD group. There was no significant difference in immune cell content, inflammatory factor level, quality of life (QOL) scores and total scores between the three groups. Except for the HD group, there was no significant difference between the two groups, the other two groups had no significant difference between the two groups, and the other two groups had no significant difference between the two groups. There was a significant difference between the two groups before and after HFHD (P0.05). Correlation analysis showed that immune cells and inflammatory factors were not correlated with the quality of life score of HD patients. The immune cells in HFHD group and HDF group were positively correlated with the quality of life except CD8~, and the inflammatory factors were negatively correlated with the quality of life except TNF- 伪. Conclusion HDF,HFHD can increase the content of immune cells, decrease the level of inflammatory factors and improve the quality of life of the patients. The effect of HFHD is better.
【作者单位】：湖北省恩施土家族苗族自治州中心医院肾内科;湖北民族学院医学院;
【基金】：国家自然科学基金面上项目(No:81560675) 湖北省教育厅中青年人才项目(No:Q20161905)
【分类号】：R692.5

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