不同血液净化方法治疗终末期肾病的疗效分析  

Efficacy of Different Blood Purification Methods in Treatment of End-stage Renal Disease

作　　者：陈峻峰 何建强[2] 巢军[2] 朱文芳[2] 夏炎[2] 余姝[2] 欧健 吴其顺 CHEN Junfeng;HE Jianqiang;CHAO Jun;ZHU Wen fang;XIA Yan;YU Zhu;OU Jian;WU Qishun(Department of Nephrology,the Third Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing J iangsu 210001,China)

机构地区：[1]南京中医药大学第三附属医院肾病科,江苏南京210001 [2]江苏大学附属医院肾内科

出　　处：《华南国防医学杂志》2018年第8期522-526,558,共6页Military Medical Journal of South China

基　　金：国家自然科学基金资助项目(81400743);南京市医学科技发展专项资金资助项目(JQX16027)

摘　　要：目的比较高通量血液透析(high-flux hemodialysis,HFHD)与其序贯联合一定频率的血液透析滤过(hemodialysis filtration,HDF)或血液灌流(hemoperfusion,HP)等杂合式血液净化方法治疗终末期肾病(end-stage renal disease,ESRD)的疗效。方法采用随机数字表法将67例维持性透析患者分为HFHD组(17例)、干预1组(17例)、干预2组(16例)、干预3组(17例)。HFHD组每周3次HFHD;干预1组:HFHD结合两周一次HDF;干预2组:HFHD结合两周一次HP;干预3组:一周两次HFHD+一周一次HDF/HP(HDF/HP间隔开);所有患者每周三次透析,每次透析时间均为4 h。观察其6个月及12个月的血压、营养、贫血、透析充分性指标及相关并发症等情况。结果观察期内4组透前血磷、全段甲状旁腺激素、尿素清除指数(Kt/V)、血红蛋白、促红素(erythropoietin,EPO)、收缩压、舒张压及透析并发症之间无统计学差异(P>0.05)。观察6个月及12个月,干预组β2微球蛋白(beta 2-microglobulin,β_2-MG)清除率显著高于HFHD组,差异有统计学意义(P<0.01)。干预3组β2-MG清除率最高。观察12个月时干预组白蛋白低于HFHD组,差异有统计学意义(P<0.01),干预3组白蛋白最低。结论 HFHD序贯结合HDF或HP较HFHD更易丢失更多的营养成分,但对β2-MG清除更好,对透析充分性、提高EPO反应性及降血压方面无优势。Objective To compare the effects of high flux hemodialysis（HFHD）and its sequential combination of hemodialysis filtration（HDF）at a certain frequency or hemoperfusion（HP）or other hybrid blood purification methods for end-stage renal disease（ESRD）.Methods Sixty-seven maintenance dialysis patients were divided into HFHD group（17 cases）,intervention group 1（17 cases）,intervention group 2（16 cases）and intervention group 3（17 cases）by random number table.HFHD group：HFHD3 times a week.Intervention group 1：HFHD ＋ biweekly HDF.Intervention group 2：HFHD ＋ biweekly HP.Intervention group 3：twice a week HFHD ＋ once a week HDF/HP（HDF/HP interval）.All patients were treated with dialysis three times a week for 4 hours.The blood pressure,nutrition,anemia,dialysis adequacy index and related complications were observed at 6 months and 12 months.Results No significantly differences were found in the predialysis serum phosphorus,intact parathroid hormone,urea clearance index（Kt/V）,hemoglobin,erythropoietin（EPO）,systolic pressure,diastolic blood pressure and dialysis complications among 4 groups during the observation period（P〉0.05）.At 6 months and 12 months,the clearance rates of beta 2-microglobulin（β2-MG）in the intervention groups were significantly higher than those in the HFHD group（P〈0.01）.The clearance rate of β2-MG in the intervention group 3 was the highest.At 12 months,the albumin levels in the intervention groups were lower than those in the HFHD group（P〈0.01）,and the albumin level in the intervention group 3 was the lowest.Conclusion HFHD sequential combination with HDF or HP is more likely to lose more nutrients than HFHD,but it is better forβ2-MG clearance and no advantage for dialysis adequacy,EPO reactivity and decreasing blood pressure.

关 键 词：高通量血液透析 Β2微球蛋白 血液灌流 血液透析滤过 

分 类 号：R459.5[医药卫生—治疗学]