摘要
目的探讨血液透析（hemodialysis，HD）联合血液灌流（hemoperfusion，HP）对维持性血液透析（maintenance hemodialysis，MHD）患者甲状旁腺素（parathyroid hormone，PTH）、胆微球蛋白（β2-microglobulin，β2-MG）、瘦素（1eptin，LIyr）等中分子毒素的清除的效果。方法选择40例MHD患者，采用自身对照研究。所有患者均先行单纯血液透析：血流量240ml／min，透析液流量500ml／min，每周3次，每次4h，共治疗15周。第16周起HP联合HD治疗：先行HP治疗，血流量180ml／min，治疗2h后取下血液灌流器，再继续进行HD2h，血流量240ml／min，透析液流量500ml／min；每周HP联合HD治疗1次，HD治疗2次，共15周。比较单纯HD治疗和HD＋HP治疗前后PTH、β2-MG、LPT水平变化。结果患者经HP＋HD治疗15周后的收缩压（systolic blood pressure，SBP）、舒张压（diastolic blood pressure，DBP）、心率（heart rate，HR）、降压药种类均显著低于单纯HD治疗；血红蛋白（hemoglobin，Hb）显著高于单纯HD治疗；而采用两种治疗方式前后患者的白蛋白（albumin，Alb）、血清铁（serum iron，SI）、总铁结合力（total iron binding capacity，T／BC）和Kt／V差异均无统计学意义。患者在HP＋HD治疗15周后，PTH和β2-MG、U）T水平有明显降低，差异有统计学意义（P〈0．05）；而在单纯HD治疗15周后，PTH和β2-MG、LPT水平治疗前后比较，差异无统计学意义（P〉0．05）。结论HP＋HD治疗较单纯HD治疗可以有效清除PTH、β2-MG、LPT等中分子物质，减少MHD患者的并发症，改善生活质量及提高生存率。
Objective To investigate the effect of hemodialysis plus hemoperfusion （HD ＋ HP） on clearance of PTH, β2-MG and LPT in patients undergoing maintenance hemodialysis （MHD）. Methods Forty patients subject to MHD were randomly selected in our hospital for self control study. All patients were given pure hemodialysis （HD group） . blood flow of 240 ml/min, dialysate flow rate of 500 ml/min, 4 h each time, 3 times a week, a total of 15 weeks. On the 16th week, HP＋ HD was given （HP＋ HD group） ; blood flow of 180 ml/min, 2 h after HP, HD for 2 h, 240 ml/min, dialysate flow rate of 500 ml/min, one time a weekt; 2 times of HD, a total of 15 weeks. The changes of PTH, β2--MG and LPT levels in two groups before and after 15 weeks of treatment were compared. Results After treatment for 15 weeks in HD＋ HP group, the systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR）, types of antihypertensive drugs were significantly reduced, and hemoglobin （Hb） was significantly increased as compared with HD group. The albumin （Alb）, serum iron （SI）, total iron binding capacity （TIBC） and Kt/V showed no significant difference between two groups. After treatment for 15 weeks in HP ＋ HD group, PTH, β2-MG and leptin levels were decreased significantly （P〈0. 05）, but there was no significant difference in HD group before and after treatment （P〈0. 05）. Conclusions HD ＋ HP treatment can more effectively scavenge PTH, β2-MG, leptin and other molecules, reduce the complieations in hemodialysis patients, improve the quality of life and increase the survival rate than single HD treatment.
出处
《临床肾脏病杂志》
2015年第5期289-292,共4页
Journal Of Clinical Nephrology
