高通量血液透析在慢性肾衰竭患者治疗中的综合评价

Comprehensive evaluation of high flux hemodialysis in the treatment of chronic renal failure patients

目的前瞻性分析高通量透析在维持性血液透析患者中的综合疗效。方法选择第四军医大学西京医院肾脏病科60例患者随机分为高通量透析组(HFHD组)和低通量透析组(LFHD组),每组各30例。其中12例患者先行LFHD治疗1．0～1．5年后改为HFHD治疗继续随访1年。HFHD组使用聚砜膜F60高通量透析器,LFHD组使用聚砜膜低通量F6HPS透析器,连续观察1年。分析HFHD组和LFHD组患者的症状改善情况,测定首次透析前与透析后血尿素氮(BUN)、肌酐(Scr)、血脂、血钙、血磷、全段甲状旁腺激素(iPTH)、β2-微球蛋白(β2-MG)、瘦素、超声心动图等指标,透析治疗1年后,复测并比较上述指标。结果①HFHD组患者皮肤瘙痒、关节疼痛、头痛、抽搐、肌肉痉挛、低血压、心律失常和浆膜腔积液等症状明显缓解;②HFHD组对血脂、血磷、iPTH、β2-MG和瘦素的清除明显高于LFHD组(P<0．05);HFHD组透析前与首次透析后和透析1年后的上述指标比较差别显著。③单次透析后,HFHD组和LFHD组均可减轻左心室心肌重量指数(LVMI)、缩小左心室舒张末期容积(LVDd),两组间差异无显著性(P>0．05),但透析1年后,两组间比较差异有显著性(P<0．05)。结论高通量血液透析有利于改善钙磷代谢紊乱和血脂代谢紊乱,对清除iPTH、β2-MG和瘦素等较大分子的毒素和改善左心室的收缩及舒张功能效果比低流量透析更显著;提示在一定范围内,可以采用高通量透滤器进行血液透析来替代血液滤过或透析滤过治疗。

Objective To prospectively investigate the efficacy of high flux dialysis in maintenance hemodialysis patients. Methods Sixty cases of hemodialysis patients were randomly and equally divided into two groups： high flux hemodialysis （HFHD） group and low flux hemodialysis （LFHD） group. Among them, 12 cases were changed to HFHD for one year after they had been treated with LFHD for 1-1.5 years. Fresenius F60 polysulfone dialyzer was used for HFHD group, and Fresenius F6HPS polysulfone dialyzer was used for LFHD group. Before and after the first dialysis, blood urea nitrogen, serum creatinine, lipids, calcium, phosphate, intact parathyroid hormone （iPTH）, β 2-microglobulin （ β 2-MG）, leptin and echocardiography were measured. After one year of dialysis, these examinations were repeated. Results In HFHD group, skin itching, arthralgia, headache, low blood pressure, muscle spasm, arrhythmia and stagnant fluid in cavities were significantly improved. The clearance of serum phosphate, lipids, iPTH, β 2-MG and leptin also increased remarkably after the first dialysis and after the dialysis for one year as compared with the results before the dialysis and those in the LFHD group （P 〈0.05）. The left ventricular mass index and left ventricular end diastolic volume lowered after one dialysis in both groups （P〉0.05）, but the two indexes were better in HFHD group than in LFHD group after the dialysis for one year. Conclusion HFHD is better than LFHD in the clearance of larger molecules such as iPTH, β 2-MG and leptin, in the recovery of calcium, phosphate and lipid metabolism and in the improvement of left ventricular diastolic and systolic functions. Therefore, HFHD may be better than hemofiltration and hemodialysis filtration in some cases.