不同血液净化方式对维持性透析患者中分子毒素清除的研究

Different blood purification methods on removing molecular toxins in maintenance dialysis patients

目的探讨不同血液净化方式对维持性血液透析患者中分子毒素清除的效果。方法采用前瞻性、随机、对照研究,60例维持性血液透析患者在每周3次的普通血液透析的基础上随机分为3组:透析组、血滤组和灌流组,每组各20例。透析组患者继续进行普通血液透析治疗;血滤组患者在普通血液透析的基础上接受每周1次的血液透析滤过治疗;灌流组在普通血液透析的基础上接受每周1次的血液灌流联合血液透析治疗。总疗程4周。以β2-微球蛋白作为中分子毒素的测定指标。采用放射免疫法测定患者试验前后血浆和透析废液中的β2-微球蛋白。结果 (1)治疗前三组患者基线临床资料(年龄、性别比、尿素清除指数、透析龄和血浆β2-微球蛋白水平)差异无统计学意义。(2)治疗后三组患者的血清肌酐(Scr)、尿素氮(BUN)、白蛋白(Alb)及血红蛋白等水平差异均无统计学意义,且与治疗前相比,差异亦均无统计学意义。(3)4周后,透析组患者透析前血浆β2-微球蛋白与治疗前相比,差异无统计学意义;血滤组患者血浆β2-微球蛋白从(28.05±4.17)mg/L降至(16.57±3.64)mg/L,与治疗前相比差异具有统计学意义;灌流组患者血浆β2-微球蛋白从(28.43±3.64)mg/L降至(10.86±3.22)mg/L,与治疗前相比差异具有统计学意义。(4)4周后,灌流组患者血浆β2-微球蛋白水平明显低于血滤组和透析组。(5)血滤组患者透析液中β2-微球蛋白水平明显高于普通透析组和灌流组。结论血液灌流可能更有效地清除透析患者血液中的中分子毒素。

Objective To explore the efficacy of different blood purification methods on removing molecular toxins in maintenance dialysis patients. Methods Sixty patients on maintenance dialysis were enrolled in this prospective, randomized, controUod trial. At the base of traditional homedialysis model （three times a week ）, all the patients were divided into three groups. Twenty patients（ hemofiltration group）were taken hemofiltration once a week for 4 weeks. The other 20 patients （ hemoperfusion group ） were taken hemoperfusion once a week for 4 weeks. The other 20 patients （dialysis group）continued present hemodialysis three times a week. Beta 2-mieroglobulin was detected as the indicator of measurement of molecular toxins by radioimmunoassay method. Predialysis blood samples and dialysis effluent were collected. Results There was no difference in terms of age,gender,urea clearing index, dialysis duration, and plasm beta 2-microglobulin among the three groups. After 4 weeks of treatment, the plasm beta 2-microglobulin in dialysis group was same to the baseline. The plasm beta 2-microglobulin in hemofiltration group decreased significantly compared with the baseline, from （28. 05 ± 4. 17 ） mg/L to （ 16. 57 ± 3.64 ） mg/L. The plasm beta 2-microglobulin in hemoperfusion group decreased significantly compared with the baseline too, from （28. 43± 3.64） mg/L to（ 10. 86 ± 3.22） mg/L. After 4 weeks of treatment, the plasm beta 2-microglobulin in hemopeffusion group was significantly lower than that in the other two groups. Conclusions The results show that hemoperfusion could more efficiently remove beta 2-microglobulin from blood in maintenance dialysis patients.