高通量血液透析对中分子物质清除效果的临床研究

Clinical evaluation of the removal of median-molecular solutes in high permeability dialysis

目的观察高通量血液透析对维持性血液透析患者中分子物质的清除效果。方法28例维持性血透超过半年且每次脱水超过3kg患者,随机分组后分别进行高通量血液透析(n=14)和常规血液透析(n=14),每周透析2次,每次4.5小时。于透析前、透析结束时检测两组患者血清β2-MG、尿素氮(BUN)、肌酐(Cr)、ALB,进行比较。结果透析前,两组间血清β2-MG、BUN、Cr和ALB浓度无显著性差异;与透析前比较,透析后高通量透析组血清β2-MG、BUN和Cr浓度显著降低(P<0.05),常规血液透析组只有血清BUN和Cr浓度降低,两组白蛋白的变化均无统计学差异;且透析后,与常规血液透析组相比,高通量透析组血清β2-MG浓度显著降低(P<0.05),但血清BUN、Cr、ALB浓度和KT/V值无明显变化。结论高通量血液透析能有效清除中分子物质,且效果明显优于常规血液透析;同时对小分子物质的清除与常规血液透析具有同样的效果;并对ALB无明显影响。

Objective： To investigate the efficacy of high permeability dialysis （HPD） on the removal of median-molecular solutes in patients treated with maintenance dialysis. Methods： 28 patients subjected to hemodialysis were randomly divided into HPD group （n = 14） and conventional hemodialysis （CHD） group （n = 14）. HPD and CHD were done 4.5 hours each time twice a week. Their levels of serum boodl urea nitrogen （BUN）, creatinine （Cr）, β2-microglobulin （β2-MG） and plasma albumin were detected before and after hemodialysis. Results： There was no significant difference in the pre-dialysis levels of serum β2-MG, BUN, Cr and ALB between two groups. In patients with HPD, the post-dialysis levels of serum β2-MG, BUN, and Cr were significantly lower than those in pre^dialysis （P 〈 0.05）. However, only the post-dialysis levels of serum BUN, and Cr were significantly lower than those in pre-dialysis, in patients with HPD, In addition, no significant difference was found between the levels of serum ALB of pre-dialysis and post-dialysis in the two groups. On the other hand, the levels of serum β2-MG were significantly lower in HPD group than those in CHD group （P 〈 0.05）. But, there was no significant difference in the post-dialysis levels of serum BUN, Cr, ALB and KT/V between two groups. Conclusion： HPD can eliminate median-molecular solutes effectively. Moreover, the efficacy is better in HPD than that in CHD, and the efficacy of the removal of small molecular solutes in HPD is similar to that in CHD. Furthermore, HPD has no effect on the levels of serum ALB.