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

Effect of different hemopurification types on autoimmunity,inflammation stress and quality of life in patients with end-stage renal disease

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（sIL-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、sIL-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（P <0.05）；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（P <0.05）。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 explore the effect of different hemopurification types on autoimmunity, inflammation stress and the quality of life in patients with end-stage renal disease (ESRD) and their correlations. Methods A total of 138 cases of ESRD patients were chosen by convenience sampling method from June 2015 to June 2016 in the Hemodialysis Center of Nephrology Department of the Central Hospital of Enshi Autonomous Prefecture. Among them 82 cases were enrolled into hemodialysis (HD) group, 39 cases into high-flux hemodialysis (HFHD) group and 17 cases into hemodiafiltration (HDF) group. The percentages of immune cells (CD4+, CD8+, CD25+, CD4+/ CD8+), serum levels of C-reactive protein (CRP), soluble interleukin-2 receptor (sIL-2R), interleukin-6 (IL-6)and tumor necrosis factor α (TNF-α), and the quality of life score were tested by flow cytometry, cell biochromatography and enzyme-linked immunosorbent assay before and 6 months after hemopurification, and then compared within a group and among different groups. Results After 6 months, the immune cells (CD4+, CD25+, CD4+/CD8+) and inflammatory factors (CRP, sIL-2R, IL-6) except for CD8+ and TNF-α were statistically different among the three groups and so were the score of subdimension and the total score of the quality of life (P < 0.05). Compared to the HD group, the levels of inflammatory factors were lowered, the content of immune cells and the subdimensional and total scores of the quality of life increased in the HDF group and the HFHD group, there were statistical significance. Among them, the immune cell levels and the subdimensional and total scores of the quality of life increased most significantly in the HFHD group, which were statistically different from those in the HDF group; the levels of the inflammatory factors dropped the most in the HDF group, which were not statistically different from those in the HFHD group. The levels of immune cells and inflammatory factors and the subdimensional and total scores of the quality of life were statistically different before and after treatment in the HDF and HFHD groups. The results of correlation analysis showed that immune cells (CD4+, CD25+, CD4+/CD8+) and inflammatory factors (CRP, sIL-2R,IL-6) were not correlated with the quality of life in the HD group (P > 0.05), were in moderately to highly positive and moderately negative correlations with the quality of life in the HFHD group and in moderately positive and negative correlations with the quality of life in the HDF group (P < 0.05). Conclusions Both HDF and HFHD can lower the levels of inflammation factors, increase immunity cell levels and improve the quality of life of ESRD patients; however, the effect of HFHD is better.