人工法off-line HDF对血液透析充分性和高同型半胱氨酸血症的影响  

Manual Off-line HDF on Hemodialysis Adequacy and Hyperhomocysteinemia

作　　者：吴飞飞 罗来敏[2] 范燕娜 张桂玲 龚燕燕[2] WU Fei-fei;LUO Lai-min;FAN Yan-na;ZHANG Gui-ling;GONG Yan-yan(Department of Nephrology,Gaoxin Hospital of the First Affiliated Hospital,Nanchang University,Nanchang 330006,China;Department of Nephrology,The First Affiliated Hospital,Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属高新医院肾内科,南昌330012 [2]南昌大学第一附属医院肾内科,南昌330006

出　　处：《实用临床医学（江西）》2024年第4期19-22,27,共5页Practical Clinical Medicine

摘　　要：目的探究人工法off-line HDF对维持性血液透析(MHD)患者透析充分性、高同型半胱氨酸血症(HHcy)的影响。方法随机选取2021至2023年于南昌大学第一附属高新医院血液透析中心稳定透析6个月以上的MHD患者30例,进行单中心自身对照研究,时长6个月。前3个月维持每周2次高通量血液透析(HFHD)联合1次on-line HDF,后3个月维持每周2次人工法off-line HDF联合1次on-line HDF。于研究第3个月、第6个月时用全自动生化分析仪检测透析前后血尿素氮(BUN)、血肌酐(SCr)、β2-微球蛋白(β2MG)、同型半胱氨酸(Hcy)、白蛋白(Alb)、C反应蛋白(CRP)、血红蛋白(Hb)、甲状旁腺素(iPTH)、磷(P)、钾(K)水平;计算血清尿素清除指数(Kt/V)、尿素下降率(URR)和β2MG清除率。结果人工法off-line HDF模式透析的Kt/V、URR及β2MG清除率均较显著高于HFHD模式透析(P<0.05);人工法off-lineHDF模式透析Kt/V、URR及β2MG清除率达到透析充分的百分率分别为83.33%、83.33%和93.33%,均显著高于HFHD模式透析(P<0.05)。与HFHD模式透析时相比,人工法off-lineHDF模式透析结束后,患者透析前Hcy水平降低,Alb水平升高(P<0.05)。结论人工法off-line HDF模式透析可显著增加Kt/V、URR和β2MG清除率,提高MHD患者的透析充分性达标率,且对HHcy具有改善作用。Objective To explore the effects of artificial off-line HDF on dialysis adequacy and hyperhomocysteinemia(HHcy)in maintenance hemodialysis(MHD)patients.Methods 30 MHD patients with maintained dialysis for more than 6 months in the Hemodialysis Center of Gaoxin Hospital of the First Affiliated Hospital of Nanchang University were randomly selected for the single-center,self-controlled study.In the first 3 months,high flux hemodialysis(HFHD)was maintained twice a week in combination with 1 on-line HDF;in the second 3 months,manual off-line HDF was maintained twice a week in combination with 1 on-line HDF.Blood urea nitrogen(BUN),blood creatinine(SCr),β2-microglobulin(β2MG),homocysteine(Hcy),albumin(Alb),C-reactive protein(CRP),hemoglobin(Hb),parathyroid hormone(iPTH),phosphorus(P),and potassium(K)levels before and after dialysis were measured with an automated biochemistry analyzer at the 3rd and 6th months of the study;the serum urea clearance index(Kt/V),urea reduction rate(URR),andβ2MG clearance were calculated.Results The Kt/V,URR andβ2MG clearance in manual off-line HDF was significantly higher than that in HFHD(P<0.05);the percentages of Kt/V,URR andβ2MG clearance in manual off-line HDF were 83.33%,83.33%and 93.33%in dialysis adequacy,respectively,all significantly higher than those in HFHD(P<0.05).The pre-dialytic blood Hcy level was significantly lower after manual off-line HDF than after HFHD,while the pre-dialytic Alb level was higher(P<0.05).Conclusions Manual off-line HDF can significantly promote Kt/V,URR andβ2MG clearance,increase the dialysis adequacy standard rate,and improve HHcy in MHD patients.

关 键 词：人工法off-line HDF 血液透析 透析充分性 高同型半胱氨酸血症 血液透析滤过 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]