聚砜膜和醋酸纤维膜透析器对急性肾损伤患者预后对比研究  

Contrast study of the dialyzers with polysulfone membranes and with cellulose diacetate membrane on the outcome of acute kidney injury

作　　者：钟波[1] 韦加美 那宇[1] 高建军[1] 

机构地区：[1]北京市解放军306医院肾内科,北京100101

出　　处：《中国血液净化》2016年第7期345-349,共5页Chinese Journal of Blood Purification

基　　金："十二五"国家科技支撑计划(2011BAI10B08)(血液净化质量改进和国产血液净化产品临床应用评价研究);"十二五"全军重大项目(AWS11J013)(战时连续性血液净化装置及多功能体外生命支持系统的研究:子课题:体外生命支持系统在重症急性肾损伤中的应用)

摘　　要：目的评估不同透析膜材料对急性肾损伤患者预后的影响，以及透析膜渗透通量的临床意义。方法我们设计了一组单中心、前瞻性、随机对照研究方案，共有102名需要透析治疗的急性肾损伤的病人进入实验。参试患者按照年龄、性别、APACHEII评分和开始进入透析的时间持续随机分入3个透析膜组群：低通量聚砜膜组、高通量聚砜膜组和改良型醋酸纤维膜组进行预后评估。统计方法采用多变量Cox比率危险模型。结果3组患者基础情况无差异，80天随访结果表明，醋酸纤维素膜组死亡率41．1％（14／34），低通量聚砜膜组死亡率58．8％（20／34），高通量聚砜膜组死亡率61．8％（21／34），3组问对比醋酸纤维素膜组患者的存活率（多变量Cox’s危险系数模型HR0．781，95％CI0．62140．827，P=0．028）存在统计学显著差异，而恢复肾功能所需要的时间（HR0．671，95％CI0．303～1．488，P=0．852）以及在恢复之前所需要的透析总次数（HR2．844，95％可信区间0．831-8．725，P=0．764）无统计学显著性差异。仅以低通量聚砜膜和高通量聚砜膜两组透析膜类型作为进入Cox回归分析的分层变量时，患者存活率无显著性差异（HR0．856，95％CI0．432～1．121，P=-0．745）。结论对于需要血液透析进行治疗的急性肾损伤患者，选择使用改良型醋酸纤维膜透析器或生物相容性高通量或低通量聚砜膜透析器，其存活率有显著差异；但透析膜通量并不影响患者的存活率。Objective To compare the outcome of acute kidney injury （AKI） patients using dialyzers with different membranes, and to estimate the clinical significance of membrane permeability by comparing the efficacies of high-flux membrane and low-flux membrane dialyzers. Methods This prospective, randomized, single-centered study included 102 AKI patients treated with hemodialysis （HD）. Patients were stratified according to age, gender, and APACHE II score, and then randomized into three dialysis membrane groups： low-flux polysulfone group, high-flux polysulfone group, and modified cellulose diacetate group. Results Baseline characteristics were similar among the 3 groups. All-cause mortality by day 80 was 41.1% （14/34） in the modified cellulose diacetate group, 58.8% （20/34） in the low-flux polysulfone group, and 61.8% （21/34） in the high-flux polysulfone group. Survival rate was significant different among the three groups （multivari- ate Cox＇s proportional hazards model, HR 0.781, 95% CI 0.621-0.827, P=-0.028）, while the period necessary for renal function recovery （P=0.852）, the flux of the membrane （HR 0.856, 95% CI 0.432- 1.121, P=-0.745）, and the number of dialysis sessions required before recovery （P=0.764） had no differences among the three groups. Conclusions The survival rate was significantly different in AKI patients using modified cellulose diacetate membrane dialyzer and those using more biocompatible high-flux or low-flux polysulfone membrane dialyzers, while their outcomes were not influenced by the flux of the membrane.

关 键 词：血液透析 急性肾损伤 生物相容性 存活率 

分 类 号：R318.16[医药卫生—生物医学工程]