不同血液净化方式对慢性肾衰竭血液透析患者β_2-微球蛋白、瘦素清除率及透析充分性的影响

Nutrion status and quality of life and clearance rate of serum β_2-microglobulin and leptin in maintainance hemodialysis patients of different dialysis modalities

目的探讨血液透析、血液透析滤过和血液灌流3种透析方式对维持性血液透析患者血清β_2-微球蛋白(β_2-MG)和瘦素的清除率、透析相关并发症发生率、营养状况及透析充分性的影响。方法42例维持性血液透析患者分为血液透析组、血液透析滤过组和血液灌流组,观察首次透析前后及透析6个月后β_2-MG和瘦素的浓度与清除率、透析相关并发症发生率及血清白蛋白、血红蛋白、体重指数的变化以及透析充分性质量评分。结果血液透析组首次透析前后血清β_2-MG和瘦素浓度无变化;血液透析滤过组和血液灌流组首次透析后血清β_2-MG和瘦素浓度较透析前降低(P<0.05);透析6个月后,血液透析滤过组和血液灌流组血清β_2-MG和瘦素浓度较血液透析组低(P<0.05);血液透析滤过组和血液灌流组首次透析后血清β_2-MG和瘦素清除率高于血液透析组(P<0.05);血液透析滤过组和血液灌流组经6个月透析治疗后血清白蛋白、血红蛋白、体重指数高于血液透析组(P<0.05)。透析过程中,血液透析滤过组和血液灌流组常见并发症发生率低于血液透析组(P<0.05),透析充分性质量评分高于血液透析组(P<0.05)。结论血液透析滤过和血液灌流两种血液净化方式比血液透析模式能较好地清除尿毒症患者体内中分子毒素,能明显减少透析相关并发症发生率,改善营养状况,提高透析充分性,改善生存质量。

Objective To study the clearance of serum β2-microglobulin （β2-MG） and serum leptin, the nutrition status, the rates of dialysis complication and the quality of life scores in maintaninance hemodialysis patients of different dialysis modalities. Methods 42 hemodialysis patients, whose health status are similar, were divided into hemodialysis group （HD）, hemodiafiltration and hemodialysis group （HDF＆HD） and hemoperfusion and hemodialysis group （HP＆HD）. The serum albumin, hemoglobin, body mass index, the clearance rate of serum β2-MG and leptin were measured after treatment. The rates of dialysis complication and quality of life scores were measured. Results Serum β2-MG and leptin were significantly lower after HDF＆HD and HP＆HD （P 〈0.05）, but not after HD in single treatment and 6 months treatment. The clearance rate of β2-MG and leptin in group HDF＆HD and HP＆HD patients were significantly greater than those of group HD （P 〈0.05）, the level of serum albumin, hemoglobin, the body mass index were significantly higher in group HDF＆HD and HP＆HD than those of group HD （P 〈0.05）. The treatment with HDF＆HD and HP＆HD could significantly reduce the rates of dialysis complication compared with those of HD （P 〈0.05）. The quality of life scores were significantly higher in group HDF＆HD and HP＆HD than those in group HD （P 〈0.05）. Conclusion HDF and HP treatment are superior to the treatment of HD for maintaninance hemodialysis patients because they can clear part of serum β2-MG and leptin, can can improve nutrition status and dialysis adequacy reduce the rates of dialysis complication, and and life quality.