不同血液净化方式对心血管稳定性影响的临床研究

Clinical study on effects of different blood purification treatment to cardiovascular stability

目的 比较不同血液净化方法对慢性肾功能衰竭（CRF）患者心血管稳定性的影响及其内在可能机制.方法 将90例CRF患者随机分为3组.A组（HD组）行每周3次标准血液透析（HD）治疗;B组（HDF组）行每周2次常规标准血液透析（HD）治疗和每周1次血液透析滤过（HDF）治疗;C组（HP组）行每周2次常规标准血液透析（HD）治疗和每周1次血液灌流（HP）联合血液透析（HD）治疗.每一方案治疗时间为10周,间隔2周,间隔期用Fresenius F6或F8行常规HD治疗,共观察6个月.比较三组患者透析过程中心血管并发症的发生率以及治疗后6个月甲状旁腺素（iPTH）、血浆肾素（RA）、血管紧张素Ⅱ（Ang Ⅱ）的变化.结果 透析过程中B组和C组患者心血管并发症发生率分别为11.3%、10.9%,较A组20.4%明显减少,治疗后iPTH、血浆肾素（RA）、血管紧张素Ⅱ（AngⅡ）较A组也均明显下降,但B组和C组间未见明显差异.结论 血液透析滤过和血液灌流治疗病人心血管稳定性更好,这可能与其能有效地清除血浆RA、AngⅡ、甲状旁腺素（iPTH）等中分子毒素有关,两者效果相当,而血液灌流由于操作简单,设备要求低,更易于基层临床普及.

Objective To compare different blood purification techniques on cardiovascular stability in patients with chronic renal failure （CRF） and its inherent possible mechanism. Methods 90patients with CRF were randomly divided into 3 groups. Group A （HD Group） was applied 3 times per week hemodialysis （HD） treatment; Group B （HDF group） 2 times a week routine standard hemodialysis （HD）treatment and 1 time a week hemodiafiltration （HDF） treatment; Group C （HP group） 2 times a week routine standard blood dialysis （HD） treatment and 1 time a week hemoperfusion （HP） combined with hemodialysis （HD） treatment. The treatment time in every group is 10 weeks, after that there was an interval of 2 weeks with a Fresenius F6 or F8 routine HD treatment , the total time was 6 months. The incidence of cardiovascular complications in the three groups during dialysis, and parathyroid hormone （iPTH）, plasma renin （RA）,angiotensin Ⅱ （Ang Ⅱ ） changes after 6 months of treatment were compared. Results During dialysis,patients of groups B and C compared with group A significantly reduced cardiovascular complications（ group B is 11.3%, group C is 10.9%, but group A is 20.4% ）, after treatment plasma iPTH, renin （RA）,angiotensin Ⅱ （Ang Ⅱ ） were also decreased significantly compared with group A, but the groups B and C had no significant difference. Conclusion Patients with Hemodialysis or hemoperfusion treatment have better cardiovascular stability, This may be associated with the effective removal of plasma RA, Ang Ⅱ , parathyroid hormone （iPTH） and other middle molecule toxins, both treatments have an equal effect due to simple operation and low equipment requirements, hemoperfusion is much easier to be carried out universally.