摘要目的 观察高通量血液透析(HFHD)对终末期肾衰竭(ESRD)患者成纤维细胞生长因子23(FGF-23)水平及微炎症状态的影响,了解HFHD在减少ESRD患者并发症上的优势.方法 回顾性分析2012年1月至2013年12月在我院血液净化中心透析治疗的ESRD患者临床资料,根据透析方式分为高通量组(30例)和低通量组(30例),记录两组患者透析前及规律透析3个月的FGF-23、血清学指标变化,分析透析患者FGF-23的影响因素及不同透析方式对微炎症状态、生化指标、透析充分性等的影响.结果 两组患者性别、年龄、基础疾病、营养状况和药物使用及治疗前的血红蛋白(Hb)、白蛋白(ALB)、估算肾小球滤过率(eGFR)、血清Ca2+、p3-、甲状旁腺激素(PTH)、FGF-23差异均无统计学意义.高通量组透析3个月后Hb[(109 ±15)比(80±14) g/L,P＜0.001]、ALB[(37 ±4)比(30 ±4) g/L,P＜0.001]、血清Ca2+[(2.2±0.3)比(1.9±0.3)mmol/L,P=0.002],1,25-二羟维生素D3[1,25-(OH)2VitD3][(35 ±7)比(26±8)pmol/L,P=0.001]均较透析前显著升高,而血清P3-[(1.6±0.4)比(2.2 ±0.4)mmol/L,P＜0.001]、C反应蛋白(GRP)[(8.2±2.3)比(12.9±1.4) mg/L,P＜0.001]、白细胞介素(IL)-6[(107 ±13)比(126±13) ng/L,P＜0.001]、PTH[(281±115)比(467±202) ng/L,P=0.001]、FGF-23[(263±83)比(383±134) ng/L,P=0.002]均较透析前显著降低.低通量组透析3个月后Hb[(98±10)比(79±11) g/L,P＜0.001]、ALB[(37 ±4)比(31 ±5) g/L,P＜0.001]、血清Ca2+[(2.2±0.2)比(1.9±0.4)mmol/L,P=0.005]均较透析前显著升高,而1,25-(OH)2 VitD3[(29±8)比(27±8)pmol/L,P=0.343]则升高不明显,血清P3-[(1.9 ±0.3)比(2.2±0.4) mmol/L,P=0.009]、CRP[(10.6±1.9)比(14.1 ±5.7)mg/L,P＜0.001]较透析前显著降低,而IL-6[(125±12)比(126±12) ng/L,P=0.743]、PTH[(439±147)比(488 ±199) ng/L,P=0.380]、FGF-23[(357±115)比(383±131) ng/L,P=0.497]降低不明显.透析3个月后高通量组p3-[(1.6±0.4)比(1.9±0.3)mmol/L,P=0.026]、CRP[(8.2±2.3)比(10.6±l.9)mg/L,P=0.001]、IL-6[(107±13)比(125±12) ng/L,P＜0.001]、PTH[(281 ±115)比(439±147) ng/L,P =0.001]、FGF-23[(263±83)比(357±115) ng/L,P=0.005]显著低于低通量组,而Hb[(109±15)比(98±10) g/L,P=0.012]、1,25-(OH)2VitD3[(35 ±7)比(29±8)pmol/L,P=0.016]较低通量组显著升高,两组透析3个月时血清Ca2、ALB、尿素清除指数(KT/V)水平差异无统计学意义.治疗3个月后,FGF-23和血清Ca2+(r=-0.344,P=0.030)、1,25-(OH)2 VitD3(r=-0.368,P=0.019)呈负相关,与ALB(r =0.319,P =0.045)、血清p3-(r =0.510,P =0.001)、PTH(r =0.763,P ＜0.001)、CRP(r =0.334,P =0.035)、IL-6(r=0.354,P=0.025)呈正相关,与是否为高通量组(r=-0.446,P=0.004)呈负相关,与Hb(r=0.052,P=0.751)、KT/V(r =0.057,P=0.728)无明显相关性.结论 高通量透析可以更好地清除FGF-23,纠正钙磷代谢紊乱,改善微炎症状态.

abstractsObjective To explore the effects of high-flux hemodialysis (HFHD) on fibroblast growth factor 23 (FGF-23) and micro-inflammatory state in end-stage renal diseases (ESRD) patients to understand the advantages of HFHD in reducing complications in ESRD patients.Methods A total of 60 subjects sheduled for hemodialysis at our hospital in 2012 were randomly divided into two groups of 3-month HFHD and 3-month low-flux hemodialysis (LFHD) (n =30 each).The levels of serum factors,such as FGF-23,were observed before and after 3-month hemodialysis to evaluate the hemodialysis sufficiency of two groups and analyze the effects of FGF-23 related factors as well as different kinds of hemodialysis on microinflammatory state,biochemical indices and dialysis sufficiency.Results Before hemodialysis,no intergroup statistical difference (P ＞ 0.05) existed in age,gender,basic disease,nutrition and levels of hemoglobin (Hb),albumin (ALB),estimated glomerular filtration rate (eGFR),Ca2+,p3-,parathyroid hormone (PTH) and FGF-23 before treatment.After 3-month hemodialysis in two groups,there were a negative correlation between FGF-23,Ca2+ or 1,25-(OH)2VitD3,a positive correlation between FGF-23 and ALB,p3-,PTH,C-reactive protein (CRP) or interleukin-6 (IL-6) and a negative correlation between FGF 23 and HFHD group (P ＜ 0.05) and no significant correlation between FGF-23 and Hb or KT/V (P ＜ 0.05).Variance analyses were conducted for each factor before and after hemodialysis,indicating that Hb,ALB and Ca2 + significantly increased in both groups after 3-month hemodialysis (P ＜ 0.05) and 1,25-(OH)2VitD3 significantly elevated in HFHD group (P ＜ 0.05) but not in LFHD (P ＞ 0.05).Serum phosphate significantly decreased after 3-month hemodialysis in both groups (P ＜ 0.05) and CRP,IL-6,PTH and FGF-23 significantly decreased in HFHD group (P ＜ 0.05),but not in LFHD group (P ＞ 0.05).The levels of P3-,CRP,IL-6,PTH and FGF-23 after 3-month hemodialysis were significantly lower in HFHD group than those in LFHD group (P ＜0.05) while the levels of Hb and 1,25-(OH)2VitD3 after 3-month hemodialysis were significantly elevated in HFHD group compared with those in LFHD group (P ＜ 0.05).And no significant inter-group difference existed in the levels of Ca2 +,ALB and KT/V.Conclusions Compared with LFHD,HFHD is superior in treating anemia and improving nutrition.And HFHD can better decrease FGF-23,correct calcium and phosphorous metabolic disorder and improve micro-inflammatory state.