高通量血液透析与联机血液透析滤过清除溶质效果比较

Comparison of the efficacy of removing solutes among on-line hemodiafiltration,high-flux hemodialysis

目的比较高通量血液透析(HFHD)和联机血液透析滤过(OL-HDF)二种不同方法对尿毒症毒素清除及营养物质的影响。方法20例维持性血液透析患者,随机分为高通量血液透析组(n=10)和联机血液透析滤过组(n=10)。HFHD组每周2次血液透析,每次4.5 h。OL-HDF组血液透析每2周3次,每次4.5 h,结合每2周血液透析滤过1次,每次4 h。分别于单次HFHD、OLhHDF治疗前、治疗结束时取血检测患者血清BUN、Scr、Na+、K+、CL-、Ca2+、P-、Co2-Cp、β2-MG、iPTH和ALB。结果二组对BUN、Scr清除率及透析前后血清白蛋白无明显差异,对Na+、K+、CL-、Ca2+、P-、Co2-Cp改善差异无显著性,二组对β2-MG、iPTH的清除率比透析前差异有显著性(P<0.05),且HFHD对β2-MG、iPTH的清除率低于OL-HDF组(P<0.05)。结论二种血液净化治疗方式对小分子溶质清除效果基本相似,并能改善酸碱平衡及电介质紊乱,且不引起蛋白质的丢失,能有效清除上述两种中大分子溶质,其中OL-HDF的清除滤更高。

Aim To compare the effect on clearing uremic toxins and changing of nutrient substance among high-flux hemodialysis and online hemodiafiltration. Methods The patients （ n = 20）with maintaining hemodialysis were divided in high-flux hemodialysis group （ n = 10） and on-line hemodiafiltration group（ n = 10） at random. HFHD group was given treatment twice every week （4.5 hours pertime）, re- spectively. OL-HDF group was given hemodialysis thrice every two weeks（4.5 hours pertime） and OL-HDF once every two weeks（4.0 hours pertime）. Their plasm levels of BUN, Scr, Na ^＋ , K ^＋ , CL^-, Ca2^＋ , P^- , Co2-Cp, β2-MG, iPTH, albumin （ ALB ）, and so on, were detected before the treatment and at the end of the treatment. The data of two groups were compared each other. Results There were no significant differences in BUN,Scr and ALB in the two groups. There were no significant differences in the improvement of Na^＋ ,K^＋ ,CL^- ,Ca^＋ ,P^- , Co2-Cp between the two groups. The clearance rates of β2-MG and iPTH were higher in two groups than those before hemodialysis （P 〈 0. 05）. The clearance rates of 132-MG and iPTH was significantly higher in OL-HDF group than in those HFHD group（P 〈0. 05）. Conclusion The clearance rates of small molecular solutes and the rectification of acid-base balance and electrolyte disturbancesare are similar to each other in the two groups. The elimination of ALB is the same in the two groups. The clearance rates of medium molecular solutes in two groups are superior to conventional hemodialysis. The clearance effect of OL-HDF group is superior to that of HFHD group.