应用高通量可复用透析器透析对尿毒症患者血清蛋白丢失的观察

Observation of serum protein loss in uremia patients treated with high-flux and reprocessable dialyzer

目的观察普通血液透析(HD),血液透析滤过(HDF)及可复用高通量血液透析(HFDR)治疗的尿毒症患者血清中蛋白质丢失情况。方法选择北京市中关村医院长期血液透析患者52例,将患者随机分为HD组(n=20)、HDF组(n=20)及HFDR组(n=12),前瞻性对照观察各组患者治疗中排出液蛋白含量及HD、HFDR治疗半年及一年后血清白蛋白量。结果①HD组排出液中蛋白浓度(1.14±0.52)mg/dl低于HFDR(1.37±0.45)mg/dl组(P<0.05);②HFDR组排出液中蛋白浓度(1.37±0.45)mg/dl明显低于HDF组(3.39±1.60)mg/dl(P<0.01);③应用全自动透析器复用机复用高通量透析器二十次内,排出液蛋白浓度无明显变化(P>0.05);④常规HD及应用HFDR治疗半年、一年后两组患者血清白蛋白浓度无明显差异[HD:(37.97±2.54)mg/dl比(36.69±1.84)mg/dl;HFDR(37.83±2.13)mg/dl比(37.26±2.46)mg/dl](P>0.05)。结论常规HD有微量蛋白丢失;HFDR在规定复用次数内不会造成蛋白质的过多丢失、不会引起血清白蛋白下降;HDF有较大量蛋白质的丢失。

Objective To observe serum protein loss in uremia patients treated with conventional hemodialysis （HD）, hemodiafiltration （HDF） and high-flux dialysis reprocessing （HFDR）. Methods We recruited 52 uremia patients treated with maintenance hemodialysis in Beijing Zhong Guan Cun Hospital, and randomly divided them into HD group （n=20）, HDF group （n=20） and HFDR group （n=12）. We prospectively observed protein content in discharged fluid in the 3 groups, and serum albumin change after HD and HFDR for half a year and one year. Results （a） Protein concentration in discharged fluid was lower in HD group （1.14 ± 0.52 mg/dl） than in HFDR group （1.37 ±0.45 mg/dl, P 〈 0.05）, and the concentration in HFDR group was significantly lower than that in HDF group （3.39 ±1.60mg/all, P 〈 0.01）. （b） Protein concentration in discharged fluid did not change significantly if the high-flux dialyzer was reused for less than 20 times after reprocessing by the automatic dialyzer reprocessing machine （P 〉 0.05）. （c） After the treatment for half a year and one year, no significant differences in serum albumin was found between HD group （half a year, 37. 97 ± 2.54 mg/dl; one year, 36.69 ±1.84 mg/dl） and HFDR group （half a year, 37.83 ±2.13 mg/dl; one year, 37.26 ±2.46mg/dl, P 〉 0.05）. Conclusions Conventional HD therapy causes less protein loss. HFDR may not result in excess protein loss and decrease of serum albumin, if the dialyzer was reused within permissible times. HDF causes more protein loss.