HFHD与HDF对终末期肾病患者透析效果的临床分析  

Clinical analysis on influence of HFHD and HFD on dialysis effect in patients with end-stage renal disease

作　　者：王贵霞[1] 李振翮[2] 张玉亮[1] 刘加强[1] 邹庆玲[3] 王沈华[4] 

机构地区：[1]山东省临沂市沂水中心医院血液透析室,276400 [2]山东省临沂市沂水中心医院急诊科,276400 [3]浙江大学医学院附属第二医院肾脏内科,浙江杭州310000 [4]浙江大学医学院附属第二医院急诊科,浙江杭州310000

出　　处：《重庆医学》2017年第7期871-874,共4页Chongqing medicine

基　　金：国家自然科学基金资助项目(810702277)

摘　　要：目的探究高通量血液透析(HFHD)和血液透析滤过(HDF)对终末期肾病(ESRD)患者的透析效果及其对患者死亡率的影响。方法选取山东省临沂市沂水中心医院ESRD患者122例,分别采用HFHD(HFHD组,n=62)和HDF(HDF组,n=60)进行透析治疗,对两组患者治疗前、后血清中各指标进行检测并比较。结果与治疗前比较,两组患者在治疗后血尿素氮(BUN)、血尿酸(BUA)、血肌酐(Scr)、血磷(P)、甲状旁腺素(PTH)、β2微球蛋白(β2-MG)及半胱氨酸蛋白酶抑制剂C(Cys-C)等指标水平均明显降低(P<0.05)。HFHD组对P、PTH、Cys-C的清除率明显高于HDF组(t=2.479、1.834、1.512,P<0.05)。两组患者的死亡率在平均随访(12.20±3.70)个月后存在显著性差异,HDF组的死亡率明显高于HFHD组(P<0.05)。多因素Cox回归分析结果表明,HFHD是影响ESRD患者死亡的重要因素(HR=0.50,95%CI:0.33~0.84,P=0.009)。结论 HFHD治疗ESRD患者对P、PTH、Cys-C的清除效果比HDF更加明显,且能降低ESRD患者的死亡率。Objective To explore the influence of high flux hemodialysis（HFHD）and hemodialysis filtration（HDF）on the dialysis effect and patients mortality in the patients with end-stage renal disease（ESRD）.Methods One hundred and twenty-two patients with ESRD in our hospitals were selected and respectively adopted HFHD（HFHD group,62cases）and HDF（HDF group,60cases）for conducting the dialysis therapy.The serum indexes before and after treatment were detected and compared between the two groups.Results Compared with before treatment,the level of blood urea nitrogen（BUN）,blood uric acid（BUA）,serum creatinine（Scr）,blood phosphorus（P）,parathyroid hormone（PTH）,β2microglobulin（β2-MG）and cysteine protease inhibitors（Cys-C）after treatment in the two groups were significantly decreased（P〈0.05）.The clearance rates of P,PTH and Cys-C in the HFHD group were significantly higher than those in the HDF group（t=2.479,t=1.834,t=1.512,P〈0.05）.The mortality after an average follow-up of（12.2±3.7）months had statistical difference between the two groups,the mortality rate in the HDF group was significantly higher than that in the HFHD group（P〈0.05）.The multivariate Cox regression analysis results showed that the HFHD was an important factor affecting death in ESRD patient（HR=0.50,95%CI：0.33-0.84,P=0.009）.Conclusion HFHD has more significant effect for clearing P,PTH,β2-MG and Cys-C than HDF in ESRD patients,moreover can reduces their mortality.

关 键 词：高通量血液透析 血液透析滤过 终末期肾病 死亡率 

分 类 号：R692.5[医药卫生—泌尿科学]