高通量血液透析清除尿毒症毒素疗效观察  

The clearance effect of highly permeable dialysis on toxin in uremia

作　　者：黄向阳[1] 黄培山[1] 宋雪霞[1] 张敏[1] 

机构地区：[1]广西医科大学第四附属医院肾内科,广西柳州545005

出　　处：《临床内科杂志》2003年第4期184-186,共3页Journal of Clinical Internal Medicine

摘　　要：目的　探讨高通量血液透析 (HPD)的临床应用价值。方法　比较常规血液透析(CHD)与HPD对尿毒症小分子毒素尿素氮 (BUN)、肌酐 (Cr)、磷 (P3 )及中大分子毒素 β2 微球蛋白( β2 M )、全段甲状旁腺激素 (iPTH)、瘦素 (Leptin)的清除效果。 结果　两种透析方法清除小分子毒素BUN、Cr效果均良好 ,而对血磷及中大分子毒素清除效果则有显著性差异 ,CHD治疗后P3 、β2 M、iPTH和Leptin下降率分别为 ( 4 3 .2 2± 6.0 9) %、( -3 .0 4± 7.91) %、( 2 5 .91± 6.5 7) %和 ( 4 .5 9± 2 .61) % ,HPD治疗后P3 、β2 M、iPTH和Leptin下降率分别为 ( 5 3 .86± 8.0 6) %、( 4 1.46± 8.18) %、( 5 1.5 6± 7.0 6) %和 ( 3 6.73± 11.78) %。结论　HPD能提高血磷及中大分子毒素的清除率 ,使透析治疗更充分 ,从而降低透析远期并发症 ,该法安全、高效 ,不需昂贵设备 。Objective To investigate the clinical application value of highly permeable dialysis(HPD).Methods The clearance effects on low molecular toxin,e.g. blood urine nitrogen(BUN),creatinine(Cr),phosphorus(P) and middle and large molecular toxin,e.g.β 2 microglobulin(β 2 M),intact parathyroid hormone(iPTH),leptin were compared between conventional hemodialysis(CHD) and HPD.Results There was little difference between the two dialysis for the clearance of low molecular toxin,BUN and Cr.But the clearance effects on P and middle and large molecular toxin were remarkably different.In the CHP groups,the clearance rates of P,β 2 M,iPTH,leptin were(43.22±6.09)%,(-3.04± 7.91)%, (25.91±6.57)%,(4.59±2.61)%,respectively.However,in HPD,the clearance rates of P were(53.86±8.06)%,β 2 M(41.46±8.18)%,iPTH(51.56±7.06)%,leptin(36.73±11.78)% respectively.Conclusion HPD can increase the clearance rate of P and middle and large molecular toxin,and make dialysis more sufficient,so that it can decrease the long term complications.HPD is a safe,efficient measure without expensive equipments.It is worth to be spread.

关 键 词：高通量血液透析 尿毒症 临床应用 血磷 中大分子毒素 清除率 

分 类 号：R692.5[医药卫生—泌尿科学] R459.5[医药卫生—外科学]