李艳娟.重大地震灾害军队机动医疗分队医学救援能力评价指标体系的构建[J].转化医学杂志,2017,6(6):366-369
重大地震灾害军队机动医疗分队医学救援能力评价指标体系的构建
A evaluation system for medical rescue capability of mobile military medical units in gravely earthquake disaster
  
DOI:
中文关键词:  慢性肾衰竭  血液透析  容量超负荷  炎症因子  心功能
英文关键词:Chronic renal failure  Hemodialysis  Volume overload  Inflammation factors  Cardiac function
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作者单位
李艳娟 海南省中医院肾病风湿科 
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中文摘要:
      目的探讨慢性肾衰竭血液透析患者容量超负荷与炎症因子、心功能的关系。方法以行维持性血液透析治疗6个月以上的非显性水肿慢性肾衰竭患者38例为研究组,血液透析后30 min采用生物电阻抗技术测定多余细胞外液和干体重(dry weight,DW),根据DW分为达标组(-1≤DW≤1,n=16)和负荷组(DW>1,n=22);30例同期健康查体志愿者为对照组。对负荷组进行为期3个月的DW调整,并根据DW是否达标分为A组(达标,n=12)和B组(未达标,n=10)2个亚组。采用酶联免疫吸附法检测研究对象炎症因子白介素-6(Interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-alpha,TNF-α)水平和心功能指标左室射血分数(left ventricular ejection fraction,LVEF)。采用Spearman相关分析法分析患者DW与血清IL-6、TNF-α水平及LVEF的关系,并采用受试者工作特征曲线分析患者血清IL-6、TNF-α水平评估对容量超负荷的价值。结果与对照组比较,研究组血清IL-6、TNF-α水平均升高(P<0.01),而LVEF则降低(P<0.01)。与达标组比较,负荷组血清IL-6、TNF-α水平均升高(P<0.01),而LVEF则降低(P<0.01)。与DW调整前比较,负荷组调整后的血清IL-6、TNF-α水平均降低(P<0.01),而LVEF则升高(P<0.01)。与A组比较,B组血清IL-6、TNF-α水平均升高(P<0.01),而LVEF则降低(P<0.01)。Spearman相关分析显示,患者DW与血清IL-6、TNF-α水平均呈正相关(r分别为0.758、0.775,P<0.05),与LVEF则呈负相关(r=-0.722、P<0.05)。受试者工作特征曲线分析,患者血清IL-6、TNF-α水平评估对容量超负荷的价值良好,其中以两者联合评估对容量超负荷的价值最优。结论慢性肾衰竭血液透析患者容量超负荷与炎症因子、心功能均密切相关,炎症因子水平可作为慢性肾衰竭血液透析患者容量超负荷评估的参考指标,而进行容量管理可能有利于慢性肾衰竭血液透析患者炎症反应的控制及心功能的改善。
英文摘要:
      ObjectiveTo investigate the relationships of volume overload, inflammation factors and cardiac functions in the chronic renal failure patients with hemodialysis. MethodsThirtyeight patients with chronic renal failure without dominant edema and with regular maintenance hemodialysis for more than six months were selected as the research group, extracellular water and dry weight (DW) detected by biological point impedance technology 30 min after hemodialysis. The patients were divided into standard group (-1≤DW≤1, n=16) and overload group (DW>1, n=22) according to DW. Thirty healthy volunteers had physical exam in the same period were selected as control group. The overload group had three months of the DW adjustment, and was divided into group A (standard, n=12) and group B (not up to standard, n=10) according to DW. Enzyme linked immunosorbent assay was used to detect the levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and left ventricular ejection fraction (LVEF). Spearman correlation analysis was applied in the analysis of the serum IL-6, TNF-α level and LVEF, and the operating characteristic curve (ROC) was applied in analyzing the value of serum IL-6, TNF-α level assessing the load capacity of the patients. ResultsCompared with control group, serum IL-6, TNF-α levels of the research group were higher (P<0.01), while the LVEF of the research group was lower (P<0.01). Compared with standard group, serum IL-6, TNF-α levels were increased (P<0.01), whereas LVEF was lower (P<0.01). Compared with before DW adjustment, serum IL-6, TNF-α levels of the overload group after 3 months of DW adjustment were lower (P<0.01), the LVEF of the overload group after 3 months of DW adjustment was increased (P<0.01). Compared with group A, serum IL-6, TNF-α levels of the group B were increased (P<0.01), whereas LVEF of the group B before and after the DW adjustment was lower (P<0.01). Correlation analysis results showed that DW were positively correlated with serum IL-6 and TNF-α level (P<0.05), and negatively correlated with LVEF (P<0.05). According to the results of ROC curve analysis, the value of serum IL-6, TNF-α level assessing the load capacity of patients with hemodialysis is good, the value of above 2 factors united to evaluate the load capacity was the best. ConclusionVolume overload in patients with hemodialysis, the inflammatory factors and cardiac function were closely related, and inflammatory factor levels may be reference index in the assessment of volume overload, and manage the volume capacity could be benefit to the control of the inflammatory response and cardiac function improvement in chronic renal failure patients with hemodialysis.
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