高通量血液透析与腹膜透析对中大分子毒素清除能力的比较  

Highly flux dialysis and peritoneal dialysis in removing macro-middle molecule solutes

作　　者：朱劲刚[1] 张敏[1] 王少艳[1] 毕会[1] 张宇[1] 闫昕[1] 龙刚[1] 

机构地区：[1]天津市人民医院肾脏病科,300121

出　　处：《国际移植与血液净化杂志》2010年第4期34-36,共3页International Journal of Transplantation and Hemopurification

摘　　要：目的观察腹膜透析、高通量血液透析清除终末期肾功能衰竭患者血液中、大分子溶质的疗效。方法维持性血液净化患者24例（观察组），采用德国Fresenius4008S容量控制型透析机和超纯碳酸氢盐透析液行高通量透析，每周3次，每周透析时间〉12h，共观察1年；选择终末期肾功能衰竭行持续性非卧床腹膜透析患者23例（对照组），行Tenckhoff卷曲管及手术置管法，采用Baxter公司生产的双联双袋透析装置及透析液每日交换6—8L，每次2L，根据腹膜平衡试验结果和机体日总出入量做相应调整。检测血液＆微球蛋白及甲状旁腺素水平；观察两组患者治疗1年前、后2种溶质含量的变化。结果通过1年规律治疗，2种透析方式均可显著降低血岛微球蛋白和甲状旁腺素水平（P〈0．05），腹膜透析对于陉微球蛋白的清除优于高通量血液透析（P〈0．01），而对于甲状旁腺素的清除两者效果相当（P〉0．05）。结论高通量血液透析对于中、大分子毒素清除能力接近腹膜透析。在我国国情下，两者均适合终末期肾功能衰竭患者长期维持性肾脏替代治疗的手段。Objective To compare the clearance of middle and large molecular substance in patients with highly flux dialysis （HFD） versus Peritoneal Dialysis （PD）. Methods 24 patients receiving end-stage renal disease （ESRD） were chosen. These cases received high flux dialysis （observed group） with three times-weekly session of more than 4 hours following up one year. All patients were dialyzed with Fresenius 4008S. And 23 patients receiving continuous ambulatory peritoneal dialysis（ control group） were chosen at the same time, and received 6-8 L per day. Blood β2-microglobulin and parathyroid hormone（gilt） were tested before and after one year＇ s dialysis. Results Compared to pretreatment , the decrease of PTH and β2-microglobulin of two groups was significant （ P 〈 0.05 ）. After one year , there was no sigulficant difference between observed group and control group in the decrease of PTH（ P 〉 0.05）. But the decreases of β2-microglobulin of control group were superior to that of observed group（ P 〈 0.01 ）. Conclusion Compared to peritoneal dialysis, highly flux dialysis, which has the nearly clearance of macro-middle molecule toxins, can become as the same important methods in maintenance dialysis.

关 键 词：血液透析 高通量透析 腹膜透析 溶质 &微球蛋白 甲状旁腺素 

分 类 号：R692.5[医药卫生—泌尿科学]