摘要目的 通过对比观察不同血液净化方式治疗前后血清相关炎症因子、脂蛋白(a)的变化及其之间的相互关系,探讨不同血液净化方式对尿毒症患者相关炎症因子及血清脂蛋白(a)的影响.方法 将75例初次透析的尿毒症患者随机分为血液透析组及血液透析滤过组,分别测定治疗前及治疗后3个月血清C反应蛋白、肿瘤坏死因子α、白细胞介素10、脂蛋白(a)浓度的变化.结果 血液透析组治疗前后血C反应蛋白、肿瘤坏死因子α浓度及白细胞介素10/肿瘤坏死因子α差异无统计学意义(均P＞ 0.05);血液透析滤过组治疗后血C反应蛋白、肿瘤坏死因子α浓度较治疗前及血液透析治疗后明显降低(P＜0.01),白细胞介素10/肿瘤坏死因子α较治疗前明显升高(P＜0.01),与血液透析治疗后比较有所升高(P＜0.05).血液透析组治疗后血清脂蛋白(a)浓度较治疗前有所降低,但差异无统计学意义(P＞0.05).血液透析滤过组治疗后血清脂蛋白(a)浓度较治疗前及血液透析治疗后明显下降(P＜0.01).脂蛋白(a)与C反应蛋白呈正相关(r=0.496),与白细胞介素10/肿瘤坏死因子α比值呈负相关(r=-0.369).结论 血液透析滤过可以通过清除部分炎症因子减轻微炎症状态,同时下调脂蛋白(a)水平,减少尿毒症患者相关并发症的发生发展.

abstractsObjective To observe the change and relationship between different blood purification methods on inflammatory factors and lipoprotein(a) before and after the treatment,and to observe the effects of different models of blood purification on microinflammatory stste,serum level inflammatory factors and lipoprotein(a) in urinemia patients.Methods Seventy-five uremic patients were randomly assigned to the hemodialysis (H D) group and the hemodiafiltration (HDF) group.The plasma concentration of C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-10(IL-10) and lipoprotein(a) (LP(a)) were determined before and 3 months after treatment.Results The levels of CRP,TNF-α and IL-10 had no significant change before and after treatment in HD group.The levels of CRP and TNF-α were significantly decreased after three months treatment in the HDF group.Compared with HD group,CRP,TNF-α and IL-10 were significantly reduced after treatment in the HDF group.There was not statistically significant in LP(a) concentration before and after the treatment in the HD group.The level of LP(a) was significantly decreased after the treatment in the HDF group,with significant difference between two groups.LP(a) showed a positive relation with CRP,while a negative relation was shown with IL-10/TNF-α ratio.Conclusions Hemodiafiltration can treat urinemia patients effectively by eliminating certain inflammatory factors,regulating microinflammatory state,decreasing serum LP(a) level in certain degree.Therefore we can decreas the risk of complications and improve the prognosis of uremic patients.