目的 探讨不同透析模式对血清成纤维细胞生长因子-21(fibroblast growth factor-21,FGF-21)、白细胞介素-18 (interleukin -18,IL-18)和马尿酸(hippuric acid,HA)水平及动脉粥样硬化的影响.方法 选择2014年1月至2017年2月在本院接受血液净化治疗的尿毒症患者80例,按照不同的治疗方法分为血液透析组和腹膜透析组,每组40例,对两组患者治疗前后的血清FGF-21、IL-18、HA水平及颈动脉内膜中层厚度和粥样硬化斑块面积进行比较分析.结果 治疗前两组患者的FGF-21、IL-18和HA水平差异无显著性(P>0.05),治疗后血液透析组患者的FGF-21和IL-18水平升高,HA水平降低,而腹膜透析组患者的FGF-21和IL-18水平降低,HA水平升高,两组差异有显著性(P<0.05).治疗前两组患者的颈动脉内膜中层厚度和粥样硬化斑块面积差异无显著性(P>0.05);治疗后血液透析组颈动脉内膜中层厚度和粥样硬化斑块面积提高,与治疗前比较差异有显著性(P<0.05),而腹膜透析组颈动脉内膜中层厚度和粥样硬化斑块面积与治疗前比较差异无显著性(P>0.05).结论 对于首次进行血液净化治疗的慢性肾功能不全患者,血液透析对于HA的清除效果要显著优于腹膜透析,而腹膜透析对于FGF-21和IL-18的清除效果优于血液透析,接受腹膜透析的患者动脉粥样硬化病变进展程度显著低于接受血液透析的患者,两种透析方法各有优势,但是在初期最好先选择腹膜透析.%Objective To explore the different dialysis modes on fibroblast growth factor -21 (FGF-21), interleukin -18 (IL-18) and hippuric acid (HA) level and the effect of atherosclerosis. Method From January 2014 to February 2017, 80 patients with uremia were treated with blood purification treatment in our hospital. The methods of treatment were divided into two groups, the hemodialysis group and the peritoneal dialysis group, there were 40 patients in each group. The effects of the two groups were compared. Result Before treatment, there was no statistical difference between the two groups of FGF-21, IL-18 and HA (P>0.05). After treatment, the patients in the hemodialysis group FGF-21, IL-18 level increased, HA level decreased, patients in the peritoneal dialysis group of with FGF-21, IL-18 levels have decreased, HA level increased, the data differences were statistically significant (P<0.05). Before treatment, there was no statistically significant difference in carotid artery intima-media thickness and atherosclerotic plaque area between the hemodialysis group and the peritoneal dialysis group (P>0.05). After treatment, the carotid artery intima-media thickness and the area of atherosclerotic plaques in the hemodialysis group increased, and the data difference was statistically significant (P<0.05). The data of carotid artery intima-media thickness and atherosclerotic plaque area in the peritoneal dialysis group were not statistically different from those before treatment (P>0.05). Conclusion For the first use of blood purification in chronic renal insufficiency patients were treated by hemodialysis, for the scavenging effect of HA was superior to peritoneal dialysis and peritoneal dialysis to remove FGF-21 and IL-18 effect significantly better than hemodialysis, the use of peritoneal dialysis patients, the atherosclerosis progression was significantly lower than that in hemodialysis patients, two dialysis methods have their own advantages, but in the early days of the best first choice for peritoneal dialysis.
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