Effect of Hybrid Blood Purification on Dialysis Adequacy，Immunity，and Inflammation in ESRD Patients with Inadequate Peritoneal Dialysis
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摘要:
目的 探究杂合型血液净化在腹膜透析不充分终末期肾病（ESRD）中的应用及对透析充分性、慢性炎症状态及安全性改善作用。 方法 选取2020年9月至2022年8月佛山市南海区人民医院腹膜透析不充分ESRD患者80例，随机分为2组，每组40例，对照组采取单纯血液透析，观察组采取杂合型血液净化，连续治疗3个月。比较2组一般资料、治疗前后血清指标[全段甲状旁腺激素（iPTH）、β2-微球蛋白（β2-MG）、胱抑素C（CysC）]、肾功能指标［尿素氮（BUN）、血肌酐（Scr）、残存肾功能（RRF）］、营养状况［血红蛋白（Hb）、白蛋白（Alb）、转铁蛋白（TRF）］、慢性炎症状态［白细胞介素-6（IL-6）、超敏C反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）］、红细胞免疫功能［红细胞免疫复合物花环率（RBC-ICR）、红细胞C3b受体（RBC-C3bR）、CD35阳性红细胞百分率］及尿素清除指数（KT/V）、并发症情况。 结果 治疗1、3个月后观察组iPTH、β2-MG、CysC水平均低于对照组，KT/V高于对照组（P < 0.05）；治疗1、3个月后观察组BUN、Scr、RRF水平均较对照组降低（P < 0.05）；治疗1、3个月后观察组Hb、Alb、TRF及CD35阳性红细胞百分率、RBC-C3bR水平高于对照组，IL-6、hs-CRP、TNF-α、RBC-ICR水平低于对照组（P < 0.05）；观察组并发症发生率7.50%与对照组20.00%相比，差异无统计学意义（P > 0.05）。 结论 杂合型血液净化运用弥散、对流及吸附原理能最大限度地清除炎症介质，提高透析充分性和红细胞免疫粘附活性，改善机体营养状态和肾功能，应用于透析不充分ESRD患者效果显著。 Abstract:Objective To explore the application of hybrid blood purification in patients with end-stage renal disease （ESRD） with inadequate peritoneal dialysis, and its effects on dialysis adequacy, chronic inflammation status, and safety improvement. Methods 80 patients with inadequate peritoneal dialysis （ESRD） in Foshan Nanhai District People's Hospital from September 2020 to August 2022 were selected and randomly divided into two groups, with 40 cases in each group. The control group received simple hemodialysis, while the observation group received hybrid blood purification continuously for 3 months. A comparison was made between the general data of the two groups, serum indicators before and after treatment [intact parathyroid hormone （iPTH）, β2-microglobulin （β2-MG）, cystatin C （CysC）], renal function indicators [blood urea nitrogen （BUN）, serum creatinine （Scr）, residual renal function （RRF）], nutritional status [hemoglobin （Hb）, albumin （Alb）, transferrin （TRF）], chronic inflammatory status [interleukin-6 （IL-6）, high-sensitivity C-reactive protein （hs-CRP）, tumor necrosis factor-alpha （TNF-α）], red blood cell immune function [red blood cell immune complex ring rate （RBC-ICR）, red blood cell C3b receptor （RBC-C3bR）, CD35-positive red blood cell percentage] and urea clearance index （KT/V）, as well as the incidence of complications. Results After 1 and 3 months of treatment, the levels of iPTH, β2-MG and CysC in the observation group were lower than those in the control group, and KT/V was higher than that in the control group （P < 0.05）; after 1 and 3 months of treatment, BUN, Scr, RRF levels were lower than those in the control group （P < 0.05）; after 1 and 3 months of treatment, the levels of Hb, Alb, and TRF in the observation group were higher than those in the control group, and the levels of IL-6, hs-CRP, and TNF-α were lower than those in the control group （ P < 0.05）; after 1 and 3 months of treatment, the percentage of CD35-positive red blood cells and RBC-C3bR level in the observation group were higher than those in the control group, and the RBC-ICR level was lower than that in the control group （P < 0.05）; the incidence of complications in the observation group was 7.50% Compared with 20.00% in the control group, the difference was not statistically significant （P > 0.05）. Conclusion Hybrid blood purification utilizes the principles of diffusion, convection, and adsorption to maximize the removal of inflammatory mediators, improve dialysis adequacy and red blood cell immune adhesion activity, enhance body nutritional status and renal function. This approach has shown significant effectiveness in ESRD patients with inadequate dialysis. -
Key words:
- Hybrid blood purification /
- Dialysis adequacy /
- End-stage renal disease /
- Chronic inflammation /
- Safety
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图 1 观察组与对照组的炎症指标变化趋势
A：血清IL-6变化趋势；B：血清TNF-α变化趋势；C：血清hs-CRP变化趋势。
Figure 1. Trends in inflammatory indicators in the observation and control groups
图 2 观察组与对照组的红细胞免疫功能变化趋势
A：CD35阳性红细胞百分率变化趋势；B：RBC-C3bR变化趋势；C：RBC-ICR变化趋势。
Figure 2. Trends in erythrocyte immune function in the observation and control groups
表 1 2组一般资料比较[（$\bar x \pm s $）/n（%）]
Table 1. Comparison of general information between the two groups[（$\bar x \pm s $）/n（%）]
组别 男/女 年龄（岁） 肾病病程（a） BMI（kg/m2） 合并症 <18.5 18.5～24.0 >24.0 高血压 糖尿病 高血脂 观察组 22/18 56.20±8.33 8.68±2.74 25（62.50） 8（20.00） 7（17.50） 7（17.50） 5（12.50） 2（5.00） 对照组 19/21 54.19±9.12 9.25±3.05 23（57.50） 11（24.50） 6（15.00） 9（22.50） 8（20.00） 3（7.50） t/χ2 0.450 1.029 0.879 0.634 0.313 0.827 0.000 P 0.502 0.307 0.382 0.728 0.576 0.363 1.000 
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表 2 2组iPTH、β2-MG、CysC、KT/V水平比较（$\bar x \pm s $）
Table 2. Comparison of iPTH，β2-MG，CysC and KT/V levels between the two groups（$\bar x \pm s $）
项目 组别 n 基线期 治疗1个月后 治疗3个月后 iPTH（pg/mL） 观察组 40 508.10±83.58 420.35±41.38ab 260.27±32.69ab 对照组 40 511.58±92.34 449.86±36.74a 384.65±53.75a F F组间=15.365，F时间=21.578，F交互=17.207 P P组间<0.001，P时间<0.001，P交互<0.001 β2-MG（mg/L） 观察组 40 50.35±9.58 41.68±6.47ab 35.65±4.54ab 对照组 40 49.32±8.28 46.11±5.12a 41.32±6.87a F F组间=5.632，F时间=11.205，F交互=7.549 P P组间<0.001*，P时间<0.001*，P交互<0.001* CysC（mg/L） 观察组 40 9.30±2.12 7.65±1.00ab 6.00±1.10ab 对照组 40 9.15±1.78 8.22±1.03a 6.95±1.49a F F组间=4.112，F时间=10.326，F交互=6.115 P P组间<0.001*，P时间<0.001*，P交互<0.001* KT/V 观察组 40 1.50±0.13 1.76±0.10ab 1.98±0.14ab 对照组 40 1.48±0.15 1.59±0.13a 1.81±0.11a F F组间=7.896，F时间=18.427，F交互=19.625 P P组间<0.001*，P时间<0.001*，P交互<0.001* 与同组基线期比较，aP < 0.05；与对照组治疗后比较，bP < 0.05；*P < 0.05。
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表 3 2组肾功能指标水平比较（$\bar x \pm s $）
Table 3. Comparison of the levels of renal function indicators between the two groups（$\bar x \pm s $）
项目 组别 n 基线期 治疗1个月后 治疗3个月后 BUN（mmol/L） 观察组 40 23.15±2.42 17.62±2.10ab 11.56±1.35ab 对照组 40 22.36±2.58 19.33±2.27a 16.48±1.61a F F组间=18.965，F时间=31.205，F交互=21.208 P P组间<0.001*，P时间<0.001*，P交互<0.001* Scr（μmol/L） 观察组 40 910.53±58.14 810.47±43.68ab 743.12±35.12ab 对照组 40 895.87±62.59 842.25±51.36a 804.20±43.69a F F组间=8.102，F时间=19.524，F交互=13.201 P P组间<0.001*，P时间<0.001*，P交互<0.001* RRF（mL/min） 观察组 40 1.33±0.52 1.21±0.45ab 1.10±0.38ab 对照组 40 1.35±0.47 1.01±0.51a 0.89±0.42a F F组间=3.562，F时间=5.102，F交互=4.003 P P组间<0.001*，P时间<0.001*，P交互<0.001* 与同组基线期比较，aP < 0.05；与对照组治疗后比较，bP < 0.05；*P < 0.05。
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表 4 2组营养状况指标比较（$\bar x \pm s $，g/L）
Table 4. Comparison of nutritional status indicators between the two groups（$\bar x \pm s $，g/L）
项目 组别 n 基线期 治疗1个月后 治疗3个月后 Hb 观察组 40 83.25±7.61 93.20±8.65ab 98.65±10.35ab 对照组 40 85.15±6.74 90.00±7.14a 94.35±9.12a F F组间=3.658，F时间=10.258，F交互=5.147 P P组间<0.001*，P时间<0.001*，P交互<0.001* Alb 观察组 40 28.21±4.78 34.32±4.32ab 38.12±6.33ab 对照组 40 29.54±3.11 31.12±3.98a 33.85±5.75a F F组间=5.132，F时间=9.578，F交互=7.625 P P组间<0.001*，P时间<0.001*，P交互<0.001* TRF 观察组 40 1.20±0.31 1.81±0.25ab 2.12±0.28ab 对照组 40 1.23±0.28 1.51±0.21a 1.68±0.30a F F组间=8.325，F时间=16.758，F交互=11.208 P P组间<0.001*，P时间<0.001*，P交互<0.001* 与同组基线期比较，aP < 0.05；与对照组治疗后比较，bP < 0.05；*P < 0.05。
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表 5 2组炎症指标比较（$\bar x \pm s $）
Table 5. Comparison of inflammatory indicators between the two groups（$\bar x \pm s $）
项目 组别 n 基线期 治疗1个月后 治疗3个月后 IL-6（ng/L） 观察组 40 155.36±22.10 132.10±13.20ab 103.68±9.77ab 对照组 40 153.24±20.57 141.12±15.48a 128.96±12.34a F F组间=12.326，F时间=15.689，F交互=13.205 P P组间<0.001*，P时间<0.001*，P交互<0.001* TNF-α（ng/L） 观察组 40 11.63±2.37 9.35±1.21ab 7.10±1.53ab 对照组 40 11.47±2.42 10.32±1.14a 8.42±1.87a F F组间=5.302，F时间=13.205，F交互=7.659 P P组间<0.001*，P时间<0.001*，P交互<0.001* hs-CRP（mg/L） 观察组 40 10.89±2.54 7.35±1.34ab 6.00±0.85ab 对照组 40 9.92±2.61 8.34±1.02a 7.02±1.21a F F组间=5.132，F时间=15.302，F交互=8.104 P P组间<0.001*，P时间<0.001*，P交互<0.001* 与同组基线期比较，aP < 0.05；与对照组治疗后比较，bP < 0.05；*P < 0.05。
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表 6 2组红细胞免疫功能指标比较[（$\bar x \pm s $），%]
Table 6. Comparison of erythrocyte immune function indexes between the two groups [（$\bar x \pm s $），%]
项目 组别 n 基线期 治疗1个月后 治疗3个月后 CD35阳性红细胞百分率 观察组 40 7.32±0.68 8.86±0.75ab 9.89±1.12ab 对照组 40 7.51±0.75 8.13±0.63a 8.74±0.87a F F组间=7.325，F时间=15.865，F交互=9.425 P P组间<0.001*，P时间<0.001*，P交互<0.001* RBC-C3bR 观察组 40 5.12±0.62 7.96±1.32ab 10.76±1.67ab 对照组 40 5.31±0.80 6.87±0.96a 8.42±1.35a F F组间=8.659，F时间=23.659，F交互=15.324 P P组间<0.001*，P时间<0.001*，P交互<0.001* RBC-ICR 观察组 40 9.24±1.22 6.89±0.75ab 5.14±0.53ab 对照组 40 8.93±1.10 7.24±0.64a 6.87±0.72a F F组间=15.302，F时间=23.547，F交互=18.423 P P组间<0.001*，P时间<0.001*，P交互<0.001* 与同组基线期比较，aP < 0.05；与对照组治疗后比较，bP < 0.05；*P < 0.05。
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