不同血液净化方式对中分子及小分子物质的清除效果研究  

Effect of Different Blood Purification Methods on the Removal of Middle and Small Molecules

作　　者：聂丽敏 闫康[2] 张国欣[1] 刘娜[1] 殷玉棉 薛兰芬[1] 

机构地区：[1]石家庄市第一医院肾内科,050011 [2]石家庄市第三医院心功能室,050011

出　　处：《医学研究杂志》2017年第3期162-167,共6页Journal of Medical Research

摘　　要：目的观察不同血液净化方式对中分子尿毒症毒素β_2-微球蛋白(β_2-MG)、甲状旁腺素(PTH)等的清除效果,为临床合理选择尿毒症患者血液净化方式提供依据。方法研究是64例在笔者医院进行血液净化治疗的尿毒症患者,同时根据血液净化方式的差异进行分组:单纯血液透析组(HD,n=30),血液透析合并血液灌流组(HD+HP,n=15),血液透析滤过组(HDF,n=19)。采集治疗前后患者血清,ELISA法检测β_2-MG、PTH水平以评价不同净化方式对中分子尿毒症毒素的清除率;检测临床肾功能指标和钙离子(Ca^(2+))、钾离子(K^+)、钠离子(Na^+)、氯离子(Cl^-),反映不同净化方式对低分子物质的清除率。结果与HD、HD+HP组比较,HDF组治疗后血液中分子物质β_2-MG和PTH水平均显著下降(P<0.01),清除效果明显;与HD组比较,HD+HP组治疗后PTH显著下降(P<0.01),治疗后β_2-MG的清除率比较,差异无统计学意义(P>0.05);3组BUN、Scr清除率、KT/V值透析前后血差异无统计学意义,Ca^(2+)、K^+、Na^+、Cl^-改善比较,差异无统计学意义(P>0.05)。结论对于尿毒症患者体内毒素的清除,HDF的清除效果最佳,其次是HD+HP,HD对中分子物质的清除无明显效果。Objective To observe the effects of different blood purification models on scavenge of medium molecule substance in uremic patients, such as β2 - microglobulin （ β2 - MG） , parathyroid hormone （PTH） ,providing a reasonable choice of blood purification methods for clinical treatment of uremia. Methods Totally 64 cases of uremia patients with blood purification treatment were selected in blood purification center of our Hospital. According to different blood purification methods, they were divided into： simple hemodialysis group （ HD, n = 30） ;combined hemoperfusion with hemodialysis group （ HD ＋ HP, n = 15 ） ; hemodiafiltration group （ HDF, n = 19 ）. Serum samples were collected before and after blood purification treatment. β2 - MG and PTH were detected by ELISA assay. Urea （BUN） , creatinine （Cr） , calcium （Ca^2＋ ） , potassium ions （K^＋ ） , sodium ions （Na^＋ ） , chloride （Cl^-） were measured by biochemical methods, in order to estimate clearance rates of different molecule weight substance by different blood purification methods. Results the Serum level of β2 - MG and PTH in HDF treatment group were significantly decreased, compared with those of HD group and HD ＋ HP group （P 〈 0.01 ） , removal efficiency significantly. The Serum level of PTH in HD ＋ HP treatment group were significantly decreased, compared with that of HD group （P 〈 0.01 ） , but the srerum β2 - MG level was no significant difference （P 〉 0. 05）. The level of BUN, SCr clearance and blood KT/V value had no significant difference between three groups. The serum [ Ca^2＋ ] , [ K^＋ ] , [ Na ^＋ ] and [ Cl^- ] had also no significant difference in three groups （P 〉 0. 05）. Conclusion For uremic patients in vivo toxin removal, HDF removal efficiency is the best, followed by HD ＋ HP, HD on the removal of molecular substances have no obvious effect.

关 键 词：血液净化 血液灌流 血液透析滤过 中分子物质 

分 类 号：R3[医药卫生—基础医学]