三醋酸纤维素膜与聚砜膜透析器在维持性血液透析患者的多中心临床研究  

A multicenter clinical study of maintenance hemodialysis patients using the dialyzer with cellulose triacetate membrane or polysulfone membrane

作　　者：陈晨[1] 张晨[1] 周光宇[1] 周华[1] 李德天[1] 郑华[2] 王文秋 王喆 CHEN Chen;ZHANG Chen;ZHOU Guang-yu;ZHOU Hua;LI De-tian;ZHENG Hua;WANG Wen-qiu;WANG Zhe(Department of Nephrology,Shengjing Hospital,China Medical University,Shenyang 110004,China;Department of Nephrology,The Central Hospital,Shenyang Medical College,Shenyang 110024,China;Department of Nephrology,General Hospital of Fuxin Mining Bureau,Fuxin 123099,China;Blood Purification Center,Northeast International Hospital,Shenyang 110623,China)

机构地区：[1]中国医科大学附属盛京医院肾脏内科,沈阳110004 [2]沈阳医学院附属中心医院肾脏内科,沈阳110004 [3]阜新市矿务局总医院肾脏内科,阜新123099 [4]东北国际医院血液净化中心,沈阳110623

出　　处：《中国血液净化》2023年第5期344-348,共5页Chinese Journal of Blood Purification

摘　　要：目的 对比长期透析治疗时,三醋酸纤维素膜(cellulose triacetate,CTA)及聚砜膜(polysulfone,PS)透析器生物相容性和溶质清除能力的差异。方法 根据患者是否耐受聚砜膜透析器,分为PS组与CTA组,对比2种透析膜单次透析前后及第12个月透析后血小板(PLT)、血红蛋白(Hb)、补体、肿瘤坏死因子-α(TNF-α)、IL-6、免疫球蛋白E(IgE)、血磷(P)、尿素氮(BUN)、β2-微球蛋白(β2-MG)、甲状旁腺激素(PTH)等差异,计算尿素清除率(urea removal rate,URR)和spKt/V。结果 单次透析后较透析前各指标差值比较PS组TNF-α差值(Z=-2.491,P=0.013)低于CTA组,而β2-MG差值(Z=-2.039,P=0.041)高于CTA组。规律血液透析治疗12个月后CTA组与PS组间血磷(Z=-2.096,P=0.036)、BUN(Z=-2.038,P=0.042)、spKt/V(t=-2.147,P=0.049)差异具有统计学意义。PS组患者在透析12个月后与透析前的血磷差值高于CTA组(t=0.114,P=0.041)。结论 (1)单次透析后,PS组TNF-α水平升高,CTA的生物相容性优于PS。CTA组对β2-MG的清除能力优于PS。(2)长期透析后,两者具有相似的生物相容性。CTA组spKt/V达到标准,对BUN、P的清除能力优于PS。Objective To compare the differences of biocompatibility and solute removal ability in maintenance hemodialysis(MHD)patients using the dialyzer with cellulose triacetate(CTA)membrane and in those using the dialyzer with polysulfone(PS)membrane.Methods The MHD patients were divided into a PS membrane group and a CTA membrane group according to the clinical responses whether or not they tol-erated the PS membrane dialyzer.The effects of the two dialyzers on serum phosphorus(P),blood urea nitro-gen(BUN),β2-microglobulin(β2-MG),parathyroid hormone(PTH),complement,IgE,TNF-α,interleukin-6(IL-6),platelet(PLT),hemoglobin(Hb),calculate urea removal rate(URR)and spKt/Vwere compared be-fore and after the first dialysis session and after the hemodialysis for 12 months.Results After the first dialy-sis session,the difference of serum TNF-αwas less(Z=-2.491,P=0.013)and the difference of serumβ2-MG was more(Z=-2.039,P=0.041)in PS membrane group than in CTA membrane group.After the hemodialysis for 12 months,the differences of P(Z=-2.096,P=0.036),BUN(Z=-2.038,P=0.042),and spKt/V(t=-2.147,P=0.049)were statistically different between the two groups;the difference of P was more in PS membrane group than in CTA membrane group(t=0.114,P=0.041).Conclusions After the first dialysis session,serum TNF-αincreased in PS membrane group,suggesting the better biocompatibility of CTA membrane dialyzer;the clearance ofβ2-MG was better in CTA membrane group than in PS membrane group.After the hemodialy-sis for 12 months,the biocompatibility became similar in both groups,spKt/Vreached the standard level in CTA membrane group,and the clearances of P and BUN were better in CTA membrane group than in PS mem-brane group.

关 键 词：血液透析 三醋酸纤维素膜 聚砜膜 生物相容性 溶质清除能力 

分 类 号：R459.5[医药卫生—治疗学]