腹膜透析与高通量血液透析对老年终末期肾病患者 氧化应激水平及细胞免疫功能的影响

Effects of peritoneal dialysis and high-flux hemodialysis on oxidative stress and cellular immune function in elderly Patients with end-stage renal disease

摘要:

目的 比较腹膜透析（PD）与高通量血液透析（HFHD）对老年终末期肾病患者氧化应激状态、 免疫功能的影响。方法 选取2016 年1 月—2018 年6 月在陕西省核工业二一五医院肾内科血液净化中心进 行规律透析治疗的维持性透析患者140 例，根据不同透析方法分为PD 组和HFHD 组，每组70 例。PD 组采 用PD 治疗；HFHD 组采用高通量血液透析治疗。观察并比较两组透析前后氧化应激状态、细胞免疫功能 及治疗期间并发症发生情况。结果 HFHD 组治疗前后超氧化物歧化酶（SOD）、谷胱甘肽氧化物酶（GSHPx） 及血清丙二醛（MAD）的差值高于PD 组（P <0.05）。HFHD 组治疗前后CD+4、CD+3 及CD+4/CD+8 的 差值高于PD 组（P <0.05）；两组治疗前后CD+8 的差值比较，差异无统计学意义（P >0.05）。两组患者透析 治疗期间心血管意外、脑血管意外、感染和营养不良等并发症发生率比较，差异无统计学意义（P >0.05）。 结论 相对于PD，HFHD 能更有效地降低老年终末期肾病患者的氧化应激水平，提高机体免疫功能。

Abstract:

Objective To compare the effects of peritoneal dialysis (PD) and high-flux hemodialysis (HFHD) on oxidative stress and immune function in elderly patients with end-stage renal disease. Methods 140 cases of maintenance dialysis patients who received regular dialysis treatment in the blood purification center of Department of Nephrology in our hospital from January 2016 to June 2018 were selected as subjects. According to different dialysis methods, patients were divided into PD group and HFHD group, each with 70 cases. PD group was treated by peritoneal dialysis and HFHD group by high-flux hemodialysis. Oxidative stress, cellular immune function and complications before and after dialysis were observed and compared. Results Compared with those before treatment, the levels of SOD and GSH-Px in PD group were significantly decreased, whereas the level of MAD was significantly increased (P < 0.05). However, in HFHD group, the levels of SOD and GSH-Px were elevated, while the level of MAD was reduced after the treatment (P < 0.05). After dialysis treatment, the count of CD+4, CD+3, CD+4/CD+8 T lymphocytes in the two groups were higher than that before dialysis treatment, and that in HFHD group was higher than that in PD group (P < 0.05). There was no significant difference in the incidence of cardiovascular accident,cerebrovascular accident, infection and malnutrition between the two groups (P > 0.05). Conclusions Compared with PD, HFHD can effectively reduce the level of oxidative stress and improve the immune function of elderly patients with end-stage renal disease.