在线血液透析滤过对维持性血液透析患者心脏结构和功能的影响

Effect of on-line hemodiafiltration on cardiac structure and function in maintenance hemodialysis patients

目的探讨规律性在线高通量血液透析滤过对维持性血液透析(maintain hemodialysis,MHD)患者左心室结构和功能的维护作用和机理。方法按一定的纳入标准选择湖北医药学院附属人民医院血液净化中心MHD患者53例,随机分为单纯透析组(HD组)和透析+透析滤过组(HD+HDF组),于治疗前及6个月后用超声心动图分别测定各患者心脏结构和功能指标(LVDd、LVVd、E/A、EF和LVMI);在以上两时间点进行体检并抽取患者血标本分别检测患者基础状态指标(MAP、Hb、BMI、SCr)和透析相关慢性损害指标(CRP、IL-1a、a2-MG、PTH)。结果入选时两组患者在基础状态指标、透析相关慢性损害指标和心功能指标方面无显著差异;经不同治疗模式治疗6个月后,HD组在基础状态指标方面变化不明显,但在CRP、IL-1a、a2-MG、PTH等指标上有轻度升高;HD+HDF组患者在基础指标的血压和血红蛋白上和透析相关慢性损害指标上较前均有好转;治疗6个月后,HD组和HD+HDF组在E/A、EF、LVMI等心功能指标上均有所减退,但HD+HDF组较HD组的减退幅度明显较小。结论在维持性血液透析患者中采用HD+HDF模式更有助于减轻患者心脏结构和功能损害。

Objective To assess the effect and mechanism of regular on-line high-flux hemodiafiltration on left ventricular structure and function in maintenance hemodialysis patients. Methods Fifty-three maintenance hemodialysis patients were recruit in this Blood Purification Center, and were randomly assigned to regular hemodialysis （HD） group or regular hemodialysis plus on-line hemodiafiltration （HD＋HDF） group. Before and after 6 months of the treatment, the left ventricular structure and function parameters （LVD d, LVVd, E/A, EF and LVMI）, the basic condition parameters （MAP, Hb, BMI and SCr）, and the HD-associated chronic injury parameters （CRP, IL-1a, a2-MG, and PTH） were determined. Results At the time of recruitment, there were no differences between the two groups in all these parameters. For the patients in HD group after 6 months treatment, there were no significant changes in basic condition parameters, but HD-associated chronic injury parameters became worse. For the patients in HD＋HDF group after 6 months treatment, the basic condition parameters of BP and Hb, and all HD-associated chronic injury parameters improved. For patients in both HD and HD＋HDF groups, all left ventricular structure and function parameters aggravated, but the degree of aggravation was less in HD＋HDF group. Conclusion Regular on-line high-flux hemodiafiltration may alleviate the damage to left ventricular structure and function in maintenance hemodialysis patients.