高通量血液透析技术在高龄尿毒症患者中的应用价值研究  

Application value of high flux hemodialysis in uremic elders

作　　者：陈燕 张广璐 Chen Yan;Zhang Guang-lu(Department of Nephrology,Xing tai Third Hospital,Xingtai 054000,China)

机构地区：[1]邢台市第三医院肾内科,054000

出　　处：《临床肾脏病杂志》2021年第8期630-635,共6页Journal Of Clinical Nephrology

基　　金：2017年河北省医学科学研究课题计划(20171766)。

摘　　要：目的探讨高通量血液透析(high flux hemodialysis,HFHD)技术在高龄尿毒症患者中应用价值。方法选取2018年10月至2020年1月邢台市第三医院年龄大于70岁的尿毒症患者102例,依据随机数字表法分为研究组与对照组各51例。常规干预基础上研究组采取HFHD治疗,对照组采取低通量血液透析(low flux hemodialysis,LFHD),均治疗12周。统计两组临床疗效、治疗前及治疗6周、12周后体内毒素相关指标如尿素氮(blood urea nitrogen,BUN)、血清肌酐(serum creatinine,Scr)、硫酸对甲酚(P-cresol sulfate,PCS)、硫酸吲哚酚(indoxyl sulfate,IS)、β2-微球蛋白(β2-microglobulin,β2-MG)、甲状旁腺激素(parathyroid hormone,PTH);中性粒细胞(neutrophils,NE)吞噬功能(吞噬率、吞噬指数);血清炎性因子如C反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)、IL-8水平;钙磷代谢指标如血钙、血磷水平,随访3个月统计两组预后。结果研究组总有效率(94.12%)高于对照组(80.39%)(P<0.05);治疗6周、12周后两组血清BUN、Scr、PCS、IS、β2-MG、PTH、CRP、TNF-α、IL-6、IL-8、血磷水平较治疗前降低,且研究组低于对照组(P<0.05);治疗6周、12周后两组NE吞噬率、NE吞噬指数较治疗前增高,且研究组高于对照组(P<0.05);治疗后1个月、2个月、3个月研究组病死率与对照组间差异无统计学意义(P>0.05)。结论采取HFHD技术治疗高龄尿毒症可有效提高治疗效果,可能与其能更有效清理体内毒素、调节血清炎性因子、钙磷代谢指标及NE吞噬功能具有一定关联性。Objective To explore the application value of high flux hemodialysis(HFHD)in uremic elders.Methods From October 2018 to January 2020,a total of 102 uremic elders aged over 70 years were selected and randomized into two groups of study and control(n=51 each).On the basis of routine intervention,study group received 12-week HFHD while control group had 12-week low flux hemodialysis(LFHD).Clinical efficacy,blood urea nitrogen(BUN),serum creatinine(Scr),p-cresol sulfate(PCS),indolyl sulfate(IS)and serum creatinine(Scr)of two groups were statistically analyzed.Andβ2-microglobulin(β2-mg),parathyroid hormone(PTH),neutrophil(NE)phagocytic function(phagocytic rate/index),serum inflammatory factors such as C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-8(IL-8)were measured.The parameters of calcium and phosphorus metabolism,such as serum calcium(CA)and phosphorus(P),were followed up for 3 months.Results The overall effective rate of study group was higher than that of control group(94.12%vs 80.39%)(P<0.05).At 6 and 12 weeks of treatment,serum BUN,Scr,PCs,IS,β2-MG,PTH,CRP and TNF-αdeclined and their levels were lower than controls.The levels of IL-6,IL-8 and P were lower in study group than those in control group(P<0.05);At 6 and 12 weeks of treatment,NE phagocytosis rate/index of two groups were higher than pre-treatment and study group was higher than control group(P<0.05);no significant inter-group difference existed in mortality at Month 1/2/3 post-treatment(P>0.05).Conclusion HFHD technology can effectively improve the therapeutic efficacy for uremic elders.It is probably correlated to a more effective removal of toxins,a modulation of serum inflammatory factors,calcium and phosphorus metabolism and NE phagocytosis.

关 键 词：尿毒症 高通量血液透析 内毒素 NE吞噬功能 钙磷代谢 

分 类 号：R692.5[医药卫生—泌尿科学]