高通量透析膜对维持性血液透析过程中溶质清除及皮肤瘙痒的作用  

Effect of high-flux dialysis membrane on uremic pruritus and solute clearance of maintenance hemodialysis patients

作　　者：毕会[1] 张敏[1] 尹彩兰[1] 龙刚[1] 

机构地区：[1]天津市人民医院肾脏病科,天津市300121

出　　处：《中国组织工程研究与临床康复》2011年第29期5493-5496,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:如何有效地清除尿毒症毒素,以减少透析患者的并发症,改善维持性血液透析患者生活质量及长期预后,一直是人们研究的热点。目的:观察高通量和低通量聚砜膜血液透析器对维持性血液透析患者溶质清除及皮肤瘙痒的作用。方法:选择皮肤瘙痒的维持性血液透析患者38例,随机分为高通量透析组和低通量透析组,每组19例。高通量透析组使用高通量透析器FX60,低通量透析组使用低通量透析器F6,均每周透析3次,每次透析4h,观察1年;检测血尿素氮、肌酐、磷、β2微球蛋白及甲状旁腺素;观察透析前后各种溶质含量的变化,计算溶质清除率和尿素清除指数(Kt/V值);用目测类比评分法评估瘙痒程度。结果与结论:两组患者透析后尿素氮、肌酐下降率差异无显著性意义(P>0.05),磷和β2微球蛋白的下降率高通量透析组均高于低通量透析组(P<0.05),两组Kt/V相比差异无显著性意义(P>0.05);治疗1年后高通量透析组甲状旁腺素显著低于低通量透析组(P<0.05),皮肤瘙痒与治疗前相比两组均有减轻(P<0.05),高通量透析组瘙痒程度评分显著低于低通量透析组(P<0.05)。提示采用高通量FX60聚砜膜透析器进行透析,不仅充分清除小分子毒素,而且增加了对于大、中分子毒素的清除,能改善维持性透析患者顽固性皮肤瘙痒症状。BACKGROUND： How to effectively remove uremic toxins, reduce complications and improve the quality of life and long-term prognosis in maintenance hemodialysis patients has been a hot spot. OBJECTIVE： To compare the effects of high-flux and low-flux polysulfone membrane dialyzers on uremic pruritus and solute remove. METHODS： Thirty-eight maintenance hemodialysis patients with uremic pruritus were randomly divided into high-flux group and low-flux group. High-flux dialyzer FX60 and low-flux dialyzer F6 were used respectively in the two groups. The dialysis was performed three times a week, once for 4 hours. All the patients were follow-up for one year. Blood urea nitrogen （BUN）, creatinine, phosphate, β2-microglobulin and parathyroid hormone （PTH） were tested, and solute clearance rate and Kt/ V value were calculated. The degree of skin itch was evaluated by the visual analogue scale （VAS）. RESULTS AND CONCLUSION： There was no significant difference between the two groups in the decrease of BUN and creatinine （P 0.05）. But the decreases of phosphate and β2-microglobulin in the high-flux group were higher than that in the low-flux group （P 0.05）. And there was no difference in Kt/V value between the two groups （P 0.05）. After one year, the decrease of PTH in the high-flux group was superior to that in the low-flux group （P 0.05）, and compared to pretreatment, the skin itch was relieved in both groups （P 0.05）, but the score in the high-flux group was better than that in the low-flux group （P 0.05）. It is indicated that the high-flux dialysis can not only clear the micromolecule toxins, but also increase the clearance of large-middle molecule toxins, and can significantly relieve uremic pruritus.

关 键 词：高通量透析 血液透析膜 溶质 皮肤瘙痒 β2微球蛋白 

分 类 号：R318[医药卫生—生物医学工程]