高通量透析对尿毒症患者心血管系统的影响及可能的机制探讨

Effect of high flux hemodialysis on cardiovascular system of uremia and possible mechanism discussion

关键词:  高通量透析  尿毒症  心脏结构和功能  血管内皮功能

Key words:  high-flux hemodialysis  uremia  cardiac structure and function  vascular endothelium function

摘要:

[目的] 观察高通量透析（HFD）对尿毒症维持透析患者心脏结构和功能以及对血管内皮功能的影响，并探讨其可能的机制。 [方法] 33例维持常规低通量血液透析患者，转换为高通量透析（FX60）6个月，试验治疗前（0个月）及治疗6个月分别进行心脏结构和功能及血管内皮功能检测、同时检测患者血清前白蛋白(PA)、白蛋白(ALB)、总胆固醇(CHOL)、三酰甘油（TG）、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、β2微球蛋白(β2-MG)、全段甲状旁腺素(PTH)、晚期糖基化终末产物（AGEs）、超敏C反应蛋白(hsCRP)、白介素-6(IL-6)水平；分别比较HFD治疗前后上述指标的变化，分析心脏结构和功能指标及血管内皮功能指标与上述检测指标之间的关系。[结果] HFD治疗后，血清ALB、HDL 水平上升，CHOL、LDL水平下降。AGEs、β2-MG、IL-6水平下降。心脏舒张早期和晚期最大血流速度比（E/A）升高，等容舒张时间（IRT）降低，治疗前后比较差异有显著性意义（P<0.05）。血管内皮依赖性舒张功能指标无进一步降低。相关分析显示，内皮依赖性血管舒张功能与β2-MG呈负相关（r=-0.382，P<0.05），与HDL呈正相关（r=0.323，P<0.05）。[结论] HFD可能改善尿毒症患者的心脏舒张功能，延缓血管内皮功能的进一步损害，其机制可能与HFD有效清除了β2-MG等中大分子毒素、有效清除了炎症介质，改善脂质代谢有关。

Abstract:

[Objective] To observe impact of high-flux hemodialysis on cardiac structure and function and vascular endothelium function. [Methods] Thirty-three patients with maintain low-flux hemodialysis coming from Dalian Central Hospital. After switching to high flux hemodialysis, all dialysis prescription kept unchanged except changed from using low-flux dialyzer to high-flux FX60 dialyzer. Pre-dialysis blood samples were collected for detecting Pre-albumin (PA), Albumin (ALB), Cholesterol(CHOL), Triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), β2-microglobulin (β2-MG), intact parathyroid hormone (iPTH), advanced glycosylation end products (AGES), high-sensitivity C reactive protein (hsCRP) and interleukin-6 (IL-6) levels at 0,and 6 months after entering the study. At the same time their cardiac structure and function, vascular endothelium function were measured. Compared with each other, and analyzed the relations among the elements. [Results] After 6 months’ treatment of HFD, ALB, HDL improved and CHOL, LDL decreased significantly, and plasma β2-MG, AGES and IL-6 levels decreased. Brachial artery endothelium-dependent-dilation (EDD) is not further impaired seriously. And heart diastolic function have obvious improvement after HFD. There are inverse correlations between EDD and β2-MG（r=-0.382， P<0.05）, and positive correlations between EDD and HDL（r=0.323， P<0.05）. [Conclusions] HFD can improve heart diastolic function and suspend the injury of endothelium function.The cause maybe is HFD efficiently removing plasma middle molecule and macromolecule toxin such as β2-MG, AGES and IL-6 level, and improving lipids metabolism.