高、低通量血液透析联合血液灌流治疗终末期肾病的临床研究  

Clinical study of high and low or flux hemodialysis combined with hemoperfusion in the treatment of end-stage renal disease

作　　者：孙晓伟 崔少远[1] 王超[1] 孟金铃 王义琴 李婵[1] 张磊[1] 林淑芃[1] Sun Xiaowei;Cui Shaoyuan;Wang Chao;Meng Jinling;Wang Yiqin;Li Chan;Zhang Lei;Lin Shupeng(Intensive Care Unit,Department of Nephrology,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心肾脏病医学部重症病区,北京100853

出　　处：《中国医刊》2021年第10期1087-1091,共5页Chinese Journal of Medicine

摘　　要：目的探讨高、低通量血液透析联合血液灌流对终末期肾病患者血清白蛋白、全段甲状旁腺激素、β2-微球蛋白(β2-microglobulin,β2-MG)水平及皮肤瘙痒发生率的影响。方法回顾性分析2008年12月至2011年12月在解放军总医院第一医学中心进行维持性血液透析治疗的122例终末期肾病患者的临床资料,根据透析方式的不同将患者分为A组(34例)、B组(43例)、C组(20例)和D组(25例)。A组给予高通量血液透析+血液灌流治疗,B组给予高通量血液透析治疗,C组给予低通量血液透析+血液灌流治疗,D组给予低通量血液透析治疗。记录四组患者治疗前、治疗12个月、24个月、36个月后的血清白蛋白水平;比较分析四组患者治疗前和治疗36个月后的全段甲状旁腺激素达标率、血清β2-MG水平和皮肤瘙痒的发生情况。结果治疗12个月、24个月、36个月后,四组患者的血清白蛋白水平与治疗前比较差异均无显著性(P>0.05);治疗12个月、24个月、36个月后,四组患者的血清白蛋白水平比较差异均无显著性(P>0.05)。与治疗前比较,A组和B组患者治疗36个月后的全段甲状旁腺激素达标率均显著升高(P<0.05);治疗36个月后,四组患者的全段甲状旁腺激素达标率比较差异均无显著性(P>0.05)。与治疗前比较,A组和B组患者治疗36个月后的血清β2-MG水平均显著降低(P<0.05);治疗36个月后,A组和B组患者的血清β2-MG水平显著低于C组和D组(P<0.05)。与治疗前比较,A组和B组患者治疗36个月后的皮肤瘙痒发生率均显著降低(P<0.05);治疗36个月后,A组和B组患者的皮肤瘙痒发生率显著低于D组(P<0.05)。结论高通量血液透析、高通量血液透析+血液灌流治疗均可有效降低终末期肾病患者的血清β2-MG水平,升高其全段甲状旁腺激素达标率和降低其皮肤瘙痒发生率。Objective To observe the effects of low or flux hemodialysis combined with hemoperfusion on serum albumin,parathyroid hormone(PTH),β2-microglobulin(β2-MG),and pruritus in patients with end-stage renal disease(ESRD).Method The clinical data of 122 patients with ESRD who received maintenance hemodialysis in the First Medical Center of Chinese PLA General Hospital from December 2008 to December 2011 were retrospectively analyzed.The patients were divided into group A(34 cases),group B(43 cases),group C(20 cases)and group D(25 cases)according to different dialysis methods.Group A was given high-flux hemodialysis+hemoperfusion,group B was given high-flux hemodialysis,group C was given low-flux hemodialysis+hemoperfusion,and group D was given low-flux hemodialysis.Serum albumin levels were recorded before treatment and after 12,24 and 36 months of treatment.The standard rate of PTH,serumβ2-MG level and the occurrence of pruritus in four groups before treatment and 36 months after treatment were compared and analyzed.Result After 12,24 and 36 months of treatment,there was no significant difference in serum albumin level in the four groups comprared with before treatment(P>0.05);After 12,24 and 36 months of treatment,there was no significant difference in serum albumin level among the four groups(P>0.05).Compared with before treatment,the standard rate of PTH in group A and group B after 36 months of treatment was significantly increased(P<0.05);After 36 months of treatment,there was no significant difference in the standard rate of PTH among the four groups(P>0.05).Compared with before treatment,the levels of serumβ2-MG in group A and group B after 36 months of treatment were significantly decreased(P<0.05);After 36 months of treatment,the levels of serumβ2-MG in group A and group B were significantly lower than that in group C and group D(P<0.05).Compared with before treatment,the incidences of pruritus in group A and group B after 36 months of treatment were significantly decreased(P<0.05);After 36 months of trea

关 键 词：低通量血液透析 高通量血液透析 血液灌流 终末期肾病 皮肤瘙痒 

分 类 号：R459.5[医药卫生—治疗学]