维持性血液透析患者应用不同血液净化方式对残余肾功能影响的临床研究  

Effects of different blood purification methods on residual renal function in patients with maintenance hemodialysis

作　　者：弓晓丽[1] 刘继红[1] 张巍[1] 赵银娥[1] 

机构地区：[1]长治医学院附属和济医院肾内科,山西长治046000

出　　处：《中国实用医刊》2015年第4期1-3,共3页Chinese Journal of Practical Medicine

摘　　要：目的 探讨不同血液净化方式对维持性血液透析（MHD）患者残余肾功能（RRF）的影响.方法 将长治医学院附属和济医院于2010年5月至2013年7月收治的维持性血液透析患者126例,按照不同血液净化方式分为高通量血液透析（HFHD）组、低通量血液透析（LFHD）组和血液透析联合血液灌流（HD＋ HP）组,每组42例.三组依次分别使用F60、F6透析器、F6透析器联合HA130血液灌流器治疗6个月,并采集患者治疗前后的血尿标本,计算RRF;同时对比分析治疗前后三组患者的三酰甘油、胆固醇、β2微球蛋白以及血磷浓度水平变化情况.结果 治疗6个月后,三组RRF均显著低于治疗前,差异有统计学意义（分别t=22.21、21.33、8.32,P均＜0.01）;HFHD组和HD＋ HF组的RRF下降率均显著低于LFHD组,差异有统计学意义（分别t=6.71、5.10,P均＜0.01）;而HFHD组RRF与HD＋ HF组比较差异未见统计学意义（P＞0.05）.同时,治疗后HFHD组和HD＋ HF组血磷、三酰甘油、β2微球蛋白及总胆固醇等水平均显著低于LFHD组,差异有统计学意义（分别t1=2.24,P＜0.05;t1=3.87,P＜0.01;t2=11.02,P＜0.01;t2=9.22,P＜0.01;t3=2.08,P＜0.05;t3=2.09,P＜0.05;t4=6.97,P＜0.01;t4=8.16,P＜0.01）;而HFHD组血磷、三酰甘油、β2微球蛋白及总胆固醇等水平与HD＋ HP组比较差异未见统计学意义（P＞0.05）.结论 维持性血液透析患者在不同血液净化过程中残余肾功能均有下降,但HFHD组和HD＋ HP组对残余肾功能的不良影响相对较小,表明HFHD组和HD＋ HP组可以最大限度地保护残余肾功能,值得在临床中推广使用.Objective To investigate the effects of different blood purification methods on residual renal function（RRF） in patients with maintenance hemodialysis（MHD）.Methods From May 2010 to July 2013,126 patients with maintenance hemodialysis in our hospital were randomly divided into three groups,low flux hemodialysis （LFHD） group,high flux hemodialysis （HFHD） group and hemodialysis combined hemoperfusion （HD ＋ HP） group,with 42 cases in each group.F6 dialyzer,F60 dialyzer,and F6 dialyzer combined with HA130 blood perfusion dialyzer,was used for 6 months in the three groups respectively.Before the treatment and after the treatment for 6 months,the patient＇ s blood and urine specimens were collected,and the renal function was calculated.Cholesterol,triglycerides,β2-microglobulin and phosphate levels were examined.Results After 6 months of treatment,residual renal function（RRF） was significantly lower than that before the treatment in the three groups,and the differences were statistically significant （t =22.21,21.33,8.32,each P ＜0.01） ; the RRF declining rates in HFHD group and HD ＋ HP group were lower than those in LFHD group,and there were significant differences （t =6.71,5.10,each P ＜0.01） ; but there was no significant difference in the RRF declining rates between HFHD groups and HD ＋ HP groups （P ＞ 0.05）.Meanwhile,the serum cholesterol,triglycerides,β2-microglobulin and phosphate levels were significantly lower in HFHD groups and HD ＋HP groups than those in LFHD groups after the treatment for 6 months（t1 =2.24,P ＜0.05; t1 =3.87,P＜0.01; t2 =11.02,P ＜0.01; t2 =9.22,P＜0.01; t3 =2.08,P ＜0.05; t3 =2.09,P＜0.05; t4 =6.97,P ＜0.01; t4 =8.16,P ＜ 0.01）,but there was no significant difference in the serum cholesterol,triglycerides,β2-microglobulin and phosphate levels between HFHD groups and HD ＋ HP groups （P ＞ 0.05）.Conclusions RRF declined in hemodialysis patients after dialysis.The decline rates are lower in HFHD and HD ＋ HF groups than that

关 键 词：维持性血液透析 残余肾功能 高通量血液透析 低通量血液透析 血液透析联合血液灌流 

分 类 号：R459.5[医药卫生—治疗学]