【摘要】：目的探討在不同血液凈化模式下,患者體內(nèi)免疫細胞、炎癥因子、生存質(zhì)量變化情況及與其之間的關系。方法采用便利抽樣法,選取2015年6月-2016年6月在該院腎內(nèi)科血液凈化中心的終末期腎病(ESRD)患者138例。其中82例為血液透析(HD)組,39例為高通量血液透析(HFHD)組,17例為血液透析濾過(HDF)組。血液凈化6個月前后,采用流式細胞儀、細胞生物法、酶聯(lián)免疫吸附法檢測3組患者的免疫細胞(CD4~+,CD8~+,CD25~+,CD4~+/CD8~+)百分比、C-反應蛋白(CRP)、可溶性白細胞介素2受體(s IL-2R)、白細胞介素6(IL-6)、腫瘤壞死因子α(TNF-α)血清含量及生存質(zhì)量(SF-36)評分,比較血液凈化前后自身及各組間的變化。結果血液凈化6個月后,3組患者體內(nèi)免疫細胞、炎癥因子除CD8~+、TNF-α外,其余免疫細胞(CD4~+,CD25~+,CD4~+/CD8~+)含量、炎癥因子(CRP、s IL-2R、IL-6)水平及生存質(zhì)量各維度評分及總評分比較,差異有統(tǒng)計學意義(P0.05);與HD組相比,HDF組、HFHD組患者體內(nèi)免疫細胞含量升高、炎癥因子水平降低、生存質(zhì)量各維度評分及總評分升高;其中HFHD組患者體內(nèi)免疫細胞含量及生存質(zhì)量各維度評分和總評分升高幅度最大,與HDF組比較,差異有統(tǒng)計學意義,HDF組患者體內(nèi)炎癥因子下降幅度最大,與HFHD組相比,差異無統(tǒng)計學意義。3組患者免疫細胞含量、炎癥因子水平、生存質(zhì)量各維度評分及總評分自身前后比較,除HD組自身前后差別無統(tǒng)計學意義外,其余兩組HDF組、HFHD組患者自身前后比較均差異有統(tǒng)計學意義(P0.05)。相關分析顯示:免疫細胞、炎癥因子與HD組患者生存質(zhì)量評分無關;HFHD組和HDF組免疫細胞除CD8~+外,其余與其生存質(zhì)量呈正相關,炎癥因子除TNF-α外,其余與其生存質(zhì)量呈負相關。結論 HDF、HFHD均可升高患者體內(nèi)免疫細胞含量,降低炎癥因子水平,提高患者生存質(zhì)量,以HFHD效果較佳。
[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 偽 (TNF- 偽) 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- 偽, 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- 偽. 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.
【作者單位】： 湖北省恩施土家族苗族自治州中心醫(yī)院腎內(nèi)科;湖北民族學院醫(yī)學院;
【基金】：國家自然科學基金面上項目(No:81560675) 湖北省教育廳中青年人才項目(No:Q20161905)
【分類號】：R692.5

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