高通量血液透析联合血液灌流治疗终末期肾病的效果研究  

Therapeutic effect of high-flux hemodialysis combined with hemoperfusion on patients with end stage renal disease

作　　者：窦林斌 张伟明[1] 王咏梅[1] 林星辉[1] 蔡宏[1] 周懿君[1] 朱铭力[1] 严玉澄[1] 倪兆慧[1] 钱家麒[1] 

机构地区：[1]上海交通大学医学院附属仁济医院肾脏科,上海200127

出　　处：《上海交通大学学报（医学版）》2015年第9期1344-1349,共6页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的探讨高通量血液透析(HFD)联合血液灌流(HP)对维持性血液透析(MHD)患者血清成纤维生长因子23(FGF23)、白介素6(IL-6)等中大分子溶质清除以及生活质量改善的影响。方法入选35例MHD患者,每周行3次透析,其中HFD 2次/周,HFD+HP 1次/周,共治疗12个月。每3个月测定血常规、血清白蛋白、血钙、血磷、全段甲状旁腺激素(i PTH)等指标。第0、6、12个月ELISA法测定血清FGF23和IL-6。研究开始和结束时分别使用SF-36量表评价患者生活质量。结果完成12个月随访的患者共33例,平均年龄为(59.06±0.64)岁,平均透析龄(178.94±51.50)个月。与治疗前比较,随访期间患者血红蛋白、血清前白蛋白、血清白蛋白、血钙、血磷、i PTH无显著变化。与治疗前比较,患者FGF23在治疗6个月后显著下降(P=0.046),在治疗12个月后进一步下降(P=0.006)。与治疗前比较,患者IL-6在治疗6个月时显著下降(P=0.015),在治疗12个月时进一步下降(P=0.015)。随访12个月后,MHD患者各项评分均有显著改善(P<0.05)。结论 HFD联合HP治疗可有效清除MHD患者中大分子毒素,是改善MHD患者生活质量的有效治疗方法。Objective To investigate the effects of combination of high-flux hemodialysis（HFD） with hemoperfusion（HP） on the removal of middle and large molecule solutes such as serum fibroblast growth factor23（FGF23） and interleukin 6（IL-6） and the improvement of life quality of patients undergoing maintenance hemodialysis（MHD）.Methods A total of 35 MHD patients were enrolled and underwent two HFD and one HFD ＋ HP per week for 12 months.Indexes such as serum albumin,hemoglobin,phosphorus,calcium,and intact parathyroid hormone（iPTH） were measured every 3 months.Serum FGF23 and IL-6 were detected by ELISA in 0,6,and 12 months.SF-36 scale was used to evaluate the life quality of patients at the beginning and end of study.Results A total of 33 patients were followed up for 12 months.The mean age was（59.06±0.64） years and mean dialysis vintage was（178.94 ± 51.50） months.Hemoglobin,pre-albumin,albumin,calcium,phosphorus,and iPTH of patients during follow-up were not significantly different from those before treatment.FGF23 decreased remarkably after being treated for 6 months（P = 0.046） and decreased continuously after being treated for 12 months（P=0.006）.IL-6 decreased remarkably after being treated for 6 months（P=0.015） and decreased continuously after being treated for 12 months（P = 0.015）.Scores of all items of MHD patients improved significantly after being followed up for 12 months（P〈0.05）.Conclusion HFD ＋ HP can efficiently remove middle and large molecule toxins and is an effect treatment for improving the life quality of MHD patients.

关 键 词：血液透析 血液灌流 成纤维生长因子23 白介素6 生活质量 

分 类 号：R692.5[医药卫生—泌尿科学]