不同血液净化方式对尿毒症大中分子毒素清除的疗效观察  

作　　者：陈理境[1] 范德墉[1] 施向东[1] 

机构地区：[1]浙江省湖州市中心医院,313000

出　　处：《浙江临床医学》2018年第3期459-461,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省湖州市科技计划公益性一般A类项目（2014GY19）

摘　　要：目的分析不同血液净化方式对维持性血液透析患者体内大中分子毒素清除效果，为，临床选择适宜透析方式提供临床依据。方法选取长期、稳定常规血液透析患者60例，且均有大中分子毒素透析不充分等情况。随机分为高通量血液透析（HFHD）组和血液透析滤过（HDF）组，每组各30例，于治疗前、治疗后3个月和6个月后分别检测血清β2微球蛋白（β2-MG）、甲状旁腺激素（PTH）、半胱氨酸蛋白酶抑制剂C（CyS—C），并比较其差异。结果治疗6个月后，PTH方面，高通量血液透析组（286．34±127．33）pg／ml比血液透析滤过组（376．04±141.74）pg／nd清除增加明显，两组比较差异有统计学意义（P〈0．05）；B2微球蛋白的方面，血液透析滤过组（11.34±1．96）mg／L比高通量血液透析组（15．41±3．02）mg／L清除增加明显，两组比较差异有统计学意义（P〈0．05）；半胱氨酸蛋白酶抑制剂C方面，高通量血液透析组（263．67±98．72）μg／d1比血液透析滤过组（345．63±105．00）μg／dl清除增加明显，两组比较差异均有统计学意义（P〈0．05）。结论两种透析方式均能清除患者体内大中分子尿毒症毒素；在清除患者体内增多的PTH、Cys—C方面，高通量血液透析更有效；在清除患者体内增多的β2-MG方面，血液透析滤过更为有效。Objective To investigate the effects of different blood purification methods on the removal of large and medium molecular toxins in maintenance hemodialysis patients, and to provide the clinical basis for selecting suitable dialysis modalities to prevent or delay the longterm complications of uremic patients. Methods Sixty MHD patients with long-term and stable hemodialysis were enrolled in this study. All of them were selected from the patients with insufficient hemodialysis. Sixty patients were randomly divided into high-flux hemodialysis （ HFHD ） group and hemodiafihration （HDF） group, 30 patients in each group, and the serum β 2-MG, PTH and Cys-C after dialysis were tested 3 months and 6 months after dialysis. Results The clearance of parathyroid hormone was significantly higher in the high-throughput hemodialysis group （286.34 ± 127.33 ） pg/mL than the hemodiafiltration group （376.04 ± 141.74 ） pg/mL, and the difference was statistically significant （ 11.34±1.96 ） mg/L higher than that in the high-throughput hemodialysis group （ 15.41± 3.02 ） , and the difference was significant （ P〈0.05 ） ; for the clearance of β2-microglobulin, the hemodiafiltration （ 263.67 ± 98.72 ） μ g/dL in the hemodiafihration group was significantly higher than that in the high-throughput hemodialysis group （ 345.63± 105.00 ）μ g/dL, （ P〈0.05 ） , and the Cystatin C removal rate was more significantly, the difference was statistically significant （P〈0.05） . Conclusion Both dialysis methods are very effective in the removal of large and medium molecular uremic toxins in patients, high volume hemodialysis is more effective in clearing up the number of PTH and Cys-C in patients, and hemodiafiltration is more effective in clearing up the increase of beta 2-MG in patients.

关 键 词：高通量血液透析 血液透析滤过 尿毒症 中大分子毒素 

分 类 号：R692.5[医药卫生—泌尿科学]