不同频次在线血液透析滤过改善MHD患者生活质量的单中心研究  

A single-center study of online hemodiafiltration with different frequency to improve quality of life in maintenance hemodialysis patients

作　　者：孙艳玲 谢华 王金玲 肖坤 冯青 林洪丽 SUN Yan-ling;XIE Hua;WANG Jin-ling;XIAO Kun;FENG Qing;LIN Hong-li(Graduate School,Dalian Medical University,Dalian 116044,China;Blood Purification Center,Dalian Renal Care Hospital,Dalian 116023,China;Department of Nephrology,The First Affiliated Hospital of Dalian Medical University,Dalian 116011,China)

机构地区：[1]大连医科大学研究生院,大连116044 [2]大连瑞凯尔肾病医院血液净化中心,大连116023 [3]大连医科大学附属第一医院肾内科,大连116011

出　　处：《中国血液净化》2023年第11期821-825,860,共6页Chinese Journal of Blood Purification

基　　金：大连市高层次人才创新支持计划项目(2021RD01)。

摘　　要：目的探讨每周1次和每周3次在线血液透析滤过(on-line hemodiafiltration,OL-HDF)对维持性血液透析(maintenance hemodialysis,MHD)患者生活质量的影响。方法选取2022年1月1日—9月30日在大连瑞凯尔肾病医院接受OL-HDF治疗的患者,根据OL-HDF治疗频次不同分为OL-HDF 1次/w组及OL-HDF 3次/w组,以OL-HDF 3次/w组患者透析龄按照1:2比例进行配对,应用肾脏病生活质量简化量表(short form-36,SF-36),从肾脏病综合评分(kidney disease component summary,KDCS)、生理综合评分(physical component summary,PCS)和心理综合评分(mental component summary,MCS)3个方面评估生活质量;应用人体成分分析仪测定瘦组织指数(lean tissue index,LTI);比较2组患者基线和随访6个月生活质量评分、LTI、肾功能、β2微球蛋白等指标。结果①共纳入102例患者,OL-HDF 1次/w组68例,OL-HDF 3次/w组34例。②2组患者随访6个月较基线变化比较:KDCS评分无统计学差异(t=0.754,P=0.453);KDCS中睡眠评估OL-HDF 3次/w组优于OL-HDF1次/w组(t=3.082,P=0.003),PCS评分和MCS评分无统计学差异(t=-0.515、-1.513,P=0.608、0.133),PCS中一般健康状况评估OL-HDF 3次/w组优于OL-HDF 1次/w组(t=2.442,P=0.016)。③随访6月时:与OL-HDF 1次/w组相比,OL-HDF 3次/w组血红蛋白(F=6.682,P=0.011)、血白蛋白(F=12.294,P=0.001)及LTI(F=7.898,P=0.007)升高;OL-HDF 3次/w组β2微球蛋白低于OL-HDF 1次/w组(F=4.710,P=0.032);OL-HDF 3次/w组spKt/V高于OL-HDF 1次/w组(F=11.975,P=0.001)。结论每周3次OL-HDF治疗可以改善MHD患者睡眠和营养状态,可能与提高患者的透析充分性有关。Objective To explore the effect of online hemodiafiltration(OL-HDF)once a week and thrice a week on quality of life in patients with maintenance hemodialysis(MHD).Methods Patients who received OL-HDF in Dalian Renal Care Hospital from January 1,2022 to September 30,2022 were selected and divided into OL-HDF once a week group and OL-HDF thrice a week group;according to the dialysis age in OL-HDF thrice a week group,dialysis age was matched at a ratio of 1:2.The Kidney Disease Quality of Life short Form(SF-36)was applied.The quality of life was assessed by kidney disease component summary(KDCS),physical component summary(PCS)and mental component summary(MCS).Lean tissue index(LTI)was measured by body composition monitor(BCM).Clinical indicators including quality of life scores,LTI,renal function andβ2 microglobulin at baseline and after 6 months were compared between the two groups.Results A total of 102 MHD patients were included in this study,including 68 patients in OL-HDF once a week group and 34 patients in OL-HDF thrice a week group.Comparison of the indicator changes at baseline and after 6 months in the two groups revealed that KDCS score had no change(t=0.754,P=0.453),the sleep assessment in KDCS was better(t=3.082,P=0.003),the scores of PCS and MCS had no changes(t=-0.515 and-1/513,P=0.608 and 0.133),and the general health assessment in PCS was better(t=2.442,P=0.016)in OL-HDF thrice a week group,as compared those in OL-HDF once a week group.Changes of the indicators after 6 months showed that hemoglobin(F=6.682,P=0.011),albumin(F=12.294,P=0.001)and LTI(F=7.898,P=0.007)were higher,β2 microglobulin was lower(25.15±3.26mg/L vs.26.96±5.15mg/L;F=4.710,P=0.032),and spKt/V was higher(1.31±0.21 vs.1.19±0.15;F=11.975,P=0.001)in OL-HDF thrice a week group,as compared those in OL-HDF once a week group.Conclusions OL-HDF treatment thrice a week improves the sleep and nutritional status in MHD patients,probably due to the better dialysis adequacy in these patients.

关 键 词：血液透析滤过 血液透析 营养状态 生活质量 

分 类 号：R459.5[医药卫生—治疗学]