高通量血液透析联合血液灌流治疗尿毒症的效果观察  

Efficacy of high-flux hemodialysis combined with hemoperfusion in the treatment of uremia

作　　者：翁明祥 李玉芳 刘春雅 Weng Mingxiang;Li Yufang;Liu Chunya(Department of Nephrology,Quzhou Hospital Affiliated to Wenzhou Medical University(Quzhou People's Hospital),Quzhou 324000,Zhejiang Province,China)

机构地区：[1]温州医科大学附属衢州医院,衢州市人民医院肾内科,衢州324000

出　　处：《中国基层医药》2025年第3期397-403,共7页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省衢州市指导性科技计划(20172045)。

摘　　要：目的观察高通量血液透析联合血液灌流治疗尿毒症的临床效果。方法选取2020年1月至2022年12月在温州医科大学附属衢州医院(衢州市人民医院)尿毒症患者80例为研究对象,进行前瞻性随机对照研究,采用随机数字表法分组,研究组40例采用高通量血液透析联合血液灌流治疗;对照组40例采用高通量血液透析治疗。采用竞争性酶联免疫法、免疫荧光测定法、全自动生化分析仪、免疫透射比浊法检测毒素清除、钙磷代谢、免疫功能、血管内皮功能;比较两组毒素清除情况、钙磷代谢、免疫功能、血管内皮功能的差异。结果与治疗前比较,治疗后两组甲状旁腺激素(PTH)、血肌酐、β_(2)-微球蛋白、血尿素氮、血磷、晚期糖基化终末产物(AGEs)、细胞间黏附分子-1(ICAM-1)、同型半胱氨酸(Hcy)均降低[PTH:(353.28±50.26)ng/L比(235.26±31.51)ng/L、(357.17±52.18)ng/L比(174.16±26.35)ng/L;肌酐:(969.47±110.44)µmol/L比(511.57±91.96)µmol/L、(957.58±121.99)µmol/L比(414.37±87.41)µmol/L;β_(2)-微球蛋白:(40.27±7.98)mg/L比(22.06±3.26)mg/L、(41.65±8.40)mg/L比(17.70±3.43)mg/L;血尿素氮:(30.64±5.63)mmol/L比(14.02±2.80)mmol/L、(30.04±5.90)mmol/L比(10.07±1.94)mmol/L;血磷:(2.23±0.49)mmol/L比(1.80±0.36)mmol/L、(2.26±0.53)mmol/L比(1.53±0.31)mmol/L;Hcy:(35.87±5.34)µmol/L比(30.93±4.65)µmol/L、(36.21±5.27)µmol/L比(20.26±4.53)µmol/L;ICAM-1:(574.96±56.81)ng/L比(419.87±40.76)ng/L、(569.84±52.37)ng/L比(384.51±35.12)ng/L;AGEs:(330.41±43.69)mg/L比(297.64±38.59)mg/L、(326.98±41.25)mg/L比(165.42±15.74)mg/L],血钙、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、免疫球蛋白A(IgA)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)、补体3(C3)、补体4(C4)均升高[血钙:(1.90±0.43)mmol/L比(2.27±0.32)mmol/L、(1.93±0.46)mmol/L比(2.61±0.36)mmol/L;IgG:(7.73±1.56)g/L比(9.21±2.04)g/L、(7.82±1.62)g/L比(10.7±2.02)g/L;IgM:(0.42±0.07)g/L比(1.29±0.11)g/L、(0.40±0.08)g/L比(1.52±0.08)g/L;Objective To investigate the efficacy of high-flux hemodialysis combined with hemoperfusion in patients with uremia.Methods Eighty patients with uremia who received treatment at the Quzhou Hospital Affiliated to Wenzhou Medical University(Quzhou People's Hospital)from January 2020 to December 2022 were selected for this prospective randomized controlled trial.Participants were grouped using a random number table method,with 40 patients in the study group receiving high-flux hemodialysis combined with hemoperfusion,and 40 patients in the control group receiving high-flux hemodialysis alone.Toxicity clearance,calcium-phosphate metabolism,immune function,and vascular endothelial function were assessed using competitive enzyme-linked immunosorbent assay,immunofluorescence assay,fully automated biochemical analyzers,and immunoturbidimetric assay.The differences in toxicity clearance,calcium-phosphate metabolism,immune function,and vascular endothelial function were compared between the two groups.Results Compared with before treatment,both groups showed a significant decrease in parathyroid hormone(PTH),blood creatinine,β_(2)-microglobulin,blood urea nitrogen,blood phosphorus,advanced glycation end products(AGEs),intercellular adhesion molecule-1(ICAM-1),and homocysteine(Hcy)after treatment.Specifically,PTH levels decreased from(353.28±50.26)ng/L to(235.26±31.51)ng/L in the control group and from(357.17±52.18)ng/L to(174.16±26.35)ng/L in the study group;blood creatinine decreased from(969.47±110.44)µmol/L to(511.57±91.96)µmol/L in the control group and from(957.58±121.99)µmol/L to(414.37±87.41)µmol/L in the study group;β_(2)-microglobulin decreased from(40.27±7.98)mg/L to(22.06±3.26)mg/L in the control group and from(41.65±8.40)mg/L to(17.70±3.43)mg/L in the study group;blood urea nitrogen decreased from(30.64±5.63)mmol/L to(14.02±2.80)mmol/L in the control group and from(30.04±5.90)mmol/L to(10.07±1.94)mmol/L in the study group;blood phosphorus decreased from(2.23±0.49)mmol/L to(1.80±0.36)mmol

关 键 词：尿毒症 肾透析 甲状旁腺素 β2微球蛋白 血管细胞黏附分子1 免疫球蛋白类 补体C3 补体C4 

分 类 号：R69[医药卫生—泌尿科学]