维持性血液透析联合血液灌流：一种安全有效的模式  

Combination of maintenance hemodialysis with hemoperfusion： a safe and effective modality

作　　者：陈舜杰[1] 陆玮[1] 季刚[1] 黄海东[1] 吴谷奋[1] 黄巍[1] 单剑萍[1] 朱淳[1] 蒋更如[1] 

机构地区：[1]上海交通大学医学院附属新华医院肾内科,200092

出　　处：《中华肾脏病杂志》2011年第1期7-11,共5页Chinese Journal of Nephrology

摘　　要：目的 探讨维持性血液透析（MHD）联合血液灌流（HP）治疗能否提高中、大分子毒素的清除率,能否改善MHD患者的生活质量并降低其病死率.方法 采用前瞻性、随机、对照性研究.选取100例MHD患者,4周试验导入期后随机分为2组.HD＋HP组（n=51）采取维持性单纯血液透析（2次/周）和HD＋HP（1次/周）治疗;HD组（n=49）采取单纯血液透析（3次/周）治疗.平均随访2年.主要观察终点为患者死亡;次要观察终点为常规临床指标、瘦素、超敏C反应蛋白（hsCRP）、白细胞介素6（IL-6）、β2微球蛋白（β2-MG）、甲状旁腺激素（PTH）、肿瘤坏死因子α（TNF-α）和SF-36量表生活质量指数.结果 2年观察期结束时,HD＋HP组患者的瘦素、hsCRP、PTH、IL-6、β2-MG和TNF-α的血清浓度和收缩压、舒张压、心率、心胸比、左室质量指数（LVMI）、EPO剂量和降压药的种类均低于HD组（均P＜0.05）;HD＋HP组患者的血红蛋白（Hb）浓度、左心室射血分数（EF）、体质量指数（BMI）均高于HD组（均P＜0.05）;2组患者的血清白蛋白（Alb）浓度、血清铁（SI）浓度、总铁结合力（TIBC）、Kt/V、每分心输出量（CO）和二尖瓣峰值流速比（E/A）差异均无统计学意义.2年观察期结束后,SF-36量表显示HD＋HP组患者的生活质量明显好于HD组,总评价值显示HD＋HP组患者总分高于HD组（P＜0.05）.2年观察期间的Kaplan-Meier生存曲线显示HD＋HP组患者具有明显的生存优势,Log-rank检验P＜0.05.HD＋HP组患者行HD＋HP时未发生严重的不良反应.结论 HD＋HP清除患者体内中大分子毒素的效果明显优于单纯性HD,同时在改善MHD患者的生活质量和提高其生存率方面有潜在的优势.Objective To investigate whether the combination of maintenance hemodialysis （MHD） with hemoperfusion（HP） can improve the clearance rate of middle- and largemolecule uremic toxins so as to improve the quality of life and reduce the mortality in MHD patients. Methods A prospective, randomized and controlled clinical trial was carried out. One hundred MHD patients were selected and then randomly divided into two groups after four weeks of run-in period. HD＋HP group received MHD alone 2 times a week and the combined treatment of HD with HP （HD＋HP） once a week, whereas HD group received MHD alone 3 times a week. The follow up lasted for mean 2 years. The primary outcome was the death of patients. Secondary end points included clinical data, leptin, high sensitive C-reactive protein （hsCRP）, interleukin 6 （IL-6）,β2 microglobulin （β2-MG）, parathyroid hormone （PTH）, tumor necrosis factor α （TNF-α） and the indexes of dimensions of Medical Outcomes Study 36-Item Short-Form Health Survey （SF-36Chinese Edition ）. Results At the end of the two-year observation, the serum concentration of leptin, hsCRP, PTH, IL-6, β2-MG and TNF-α, systolic blood pressure （SBP）, diastolic blood pressure（DBP）, heart rate（HR）, cardiothoracie ratio, left ventricular mass index （LVMI）, EPO dose and the types of antihypertensive drugs used were lower in HD ＋HP group as compared to HD group （all P〈0.05）. HD＋HP group had higher hemoglobin （Hb）, ejection fraction （EF） and body mass index （BMI） （all P〈0.05）. No significant differences between two groups were found in terms of serum albumin （Alb）, serum iron （SI）, total iron binding capacity （TIBC）, cardiac output （CO）,Kt/V, early/atrial mitral inflow velocities （E/A） （all P〉0.05）. Besides, the SF-36 indicated that the total score of overall dimensions in HD＋HP group was higher （P〈0.05） and the quality of life of HD＋HP group was evidently better as compared to HD group. The Kapla

关 键 词：血液透析 血液灌流 生活质量 毒素 

分 类 号：R692.5[医药卫生—泌尿科学]