随机试验表明在血液透析或血液过过程中没有完整的肠道细菌的转移
Paul A Rootjes1,2,3, Muriel P C Grooteman1,2, Andries E Budding4
1Amsterdam UMC, location AMC, Nephrology, Amsterdam, the Netherlands.
Kidney international reports
|January 15, 2025
概括
高容量血液过 (HV-HDF) 与标准血液透析 (HD) 相比,没有显示减少细菌转位或急性相应反应. 在HV-HDF中,由于更好地维护肠道完整性,高生存率不太可能.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 密集护理医学 密集护理医学
- 微生物学 微生物学
背景情况:
- 高容量血液过 (HV-HDF) 与较低的死亡率有关,可能是由于保持了肠道 perfusion 和减少了细菌转移.
- 细菌转移引起的全身炎症是血液透析患者的一个担忧.
研究的目的:
- 与标准血液透析 (HD) 和低容量HDF (LV-HDF) 相比,研究HV-HDF是否可以降低细菌转移和急性相应反应 (APR).
- 评估不同透析方式对微生物DNA (mDNA) 和APR标记物的影响.
主要方法:
- 一项交叉研究将40名患者随机分为标准的HD,凉爽的HD,LV-HDF和HV-HDF,分别为2周.
- 在透析前后对血液中mDNA的定量评估和APR标记物的评估 (hs-CRP,IL-6R,sCD14,VCAM-1).
主要成果:
- 在所有模式的任何样本中都没有检测到微生物DNA (mDNA).
- 一般来说,APR标记在开始时增加,但在对血度进行校正后大多下降.
- 高灵敏度C反应蛋白 (hs-CRP) 仅在凉爽的HD和HV-HDF中增加,但在调整后在凉爽的HD中减少.
结论:
- 在任何透析方式中都无法证明循环的mDNA.
- APR标志物在各种模式中显示出类似的趋势,在血度修正后,大多数稳定或下降.
- 在HV-HDF中观察到的优异生存率不太可能由改善的肠道完整性或减少的APR来解释.
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