血液净化对尿毒症患者血磷清除影响因素的研究

The effect of blood purification on clearance of serum phosphate in uremia patients

目的本研究回顾性分析血液净化对尿毒症患者血磷清除效果及影响因素。方法回顾性分析了67例北京大学人民医院肾内科血液净化中心维持性血液透析(MHD)患者,其中男性28例,女性39例,年龄17～87岁,平均(58.4±14.5)岁。收集2004年4月～2005年3月一年来临床资料及透析资料,分析应用不同透析器、不同血液净化方式及不同红细胞压积(Hct)下对透析效果的影响。结果血液透析(HD)和血液滤过(HF)前血磷差异无显著性,血液净化后血磷下降明显(P<0.001);HF组较HD组血磷下降更显著(P<0.001)。用聚砜膜F6(PS)、醋酸纤维膜FB-130A(CA)、血仿膜H1480(HE)透析器血液透析前血磷差异无显著性,透析后血磷下降明显(P<0.001);HE组血磷较PS组和CA组明显降低(P<0.05)。Hct<25.00%(A组)、25.00%～29.99%(B组)、30.00%～34.99%(C组)、35.00%以上(D组)各组透析前血磷差异无显著性,透析后血磷明显降低(P<0.001)。当Hct<25.00%时,随着Hct升高,血磷下降率轻度升高,差异无显著性;当Hct>25.00%后,随着Hct的升高,血磷清除下降,B组和D组差异有显著性(P<0.05)。结论本研究显示,不同血液净化方式均能有效清除血磷,HF对磷的清除作用明显优于HD。血液透析中HE膜对磷的清除能力优于CA膜和PS膜。当Hct<25.00%时,随着Hct升高,血磷清除轻度增加,当Hct>25.00%后,随着Hct的升高,血磷清除明显下降。

Objective To observe the effect of removing serum phosphate in maintenance hemodialysis patients with different kinds of dialyzers and modes of blood purification retrospectively. Methods Sixty-seven patients （28 male, 39 female）,median age （58.4±14.5） years, who received long term hemodialysis were enrolled. We collected 1 year clinical and dialysis data and analyzed the levels of serum phosphate before and after dialysis with different kinds of dialyzers and different modes of blood purification retrospectively. Results The serum phosphate levels had no significant difference between hemodialysis （HD） and hemofiltration （HF） patients before blood purification. The level of serum phosphate of HF group decreased significantly compared with that of HD group after blood purification （P〈0.001）. The serum phosphate levels of different dialysis membrane group had no significant difference before blood purification. The mean of serum phosphate in hemophan （HE） group decreased greatly comparing with those of polysulfon （PS） group and cellulose acetate （CA） group after blood purification （P〈0.05）. The levels of serum phosphate were no significant difference among all groups of different hematocrit before blood purification. When hematocrit was less than 25% （group A）, the decline rate of serum phosphate raised mildly with increased hematocrit. When hematocrit was more than 25.00%, the clearance rate of serum phosphate decreased with increased hematocrit. The mean of serum phosphate in group B （the range of hematocrit：25.00%-29.99%） decreased greatly comparing with that of group D （hematocrit：≥35.00%） after blood purification （P〈0.05）. Conclusion Phosphate removal of HE membrane was better than CA membrane and PS membrane. Phosphate elimination by HF was much better than that by HD. When hematocrit was less than 25.00%, the decline rate of serum phosphate raised mildly with increased hematocrit. When hematocrit was more than 25%.00, the clearance rate of serum phosphate decreased greatly with increased hematocrit.