中长期血液透析联合血液灌流对维持性血液透析患者血管内皮功能的影响

Observation of medium and long term efficacy of hemodialysis combined with hemoperfusion on the endothelial function in patients with maintance hemodialysis

目的前瞻性观察中长期应用血液透析(HD)联合血液灌流(HP)对维持性血液透析患者的血管内皮功能的保护作用。方法选取我院60例维持性血液透析患者共60例,随机分为两组:HD组和HP联合HD(HP+HD)组。所有患者每周血液透析3次,其中,HP+HD组每周1次血液透析联合血液灌流,共治疗6个月。比较治疗前、治疗3个月及治疗6个月的C反应蛋白(CRP)、血红蛋白(HB)、白蛋白(ALB)、胆固醇(CHOL)、甘油三酯(TG)、血清晚期糖基化终产物(AGEs)、同型半胱氨酸(Hcy)、细胞黏附因子(ICAM)浓度。结果治疗6个月后,HP+HD组的CRP、AGEs、Hcy和ICAM水平均较本组治疗前和HD组治疗后降低(P<0.05),HB和ALB均较本组治疗前和HD组增高(P<0.05)。两组治疗前后的CHOL及TG差异无统计学意义。结论中长期应用HD联合HP治疗可有效清除AGEs、Hcy及ICAM,并改善营养状态,为减少维持性血液透析患者心血管疾病的发生率,降低死亡率,提高生活质量,提供了安全、简便、有效的治疗途径。

Objective To assess the medium and long term efficacy of hemodialysis combined with hemo-perfusion on the endothelial function in patients with maintance hemodialysis（MHD）. Methods 60 stable MHDpatients were enrolled in the research and randomly divided into 2 group. The observation group received hemodialy-is combined blood perfusion,and the control group received pure hemodialysis therapy. Blood was collected beforeand after treatment for 6 months for detection of serum C-reactive protein（CRP）,hemoglobin（HB）,albumin（ALB）,advanced glycation end products（AGEs）,homocysteine（Hcy）and intercellular cell adhesion molecule（ICAM）. Results Plasma hs-CRP,AGEs,Hcy and ICAM decreased gradually after the treatment for 6 months.Compared with the indexes before treatment,serum HGB and ALB increased significantly after the treatment for 6 months（P 0.05）. Conclusions Hemodialysis combined with hemoperfusion with an appropriate frequency andin a medium or long period is a safe,convenient,and effective approach for MHD patients to pretect the endotheli-al function.