高通量与常规血液透析临床效果对比研究

Comparison of clinical effect between high-flux hemodialysis and hemodialysis

目的:研究高通量血液透析与常规血液透析在维持性血液透析患者中的临床应用,并比较两种透析的效果。方法:选取在我科治疗的维持性血液透析患者60例,随机分为对照组和观察组各30例,观察组采取高通量血液透析治疗,对照组为常规模式透析,在治疗前、后分别测定炎症因子、血脂、血浆蛋白的变化并比较分析其临床效果。结果:(1)治疗前、后组内比较,观察组治疗后hs-CRP为(6.84±2.12)mg/L、IL-6为(31.20±6.06)ng/L、TNF-α为(1.14±0.89)μg/L,均较治疗前明显降低(P<0.05),对照组治疗前后炎症因子指标变化差异无统计学意义(P>0.05);(2)治疗后两组组间比较,观察组hs-CRP、IL-6、TNF-α均明显低于对照组(P<0.05)。(3)疗前、后血脂、血浆蛋白指标的组内比较,观察组治疗后总胆固醇为(3.72±0.54)mmol/L、甘油三酯为(0.82±0.45)mmol/L,均较治疗前明显降低(P<0.05),对照组治疗前后血脂指标变化差异不明显(P>0.05);治疗前、后指标组内比较,观察组治疗后β2微球蛋白为(27.54±13.49)μg/mL,较治疗前明显降低(P<0.05),而TP为(70.12±3.24)g/L以及ALB为(39.20±0.68)g/L,较治疗前明显升高(P<0.05),对照组治疗前、后蛋白指标变化差异无统计学意义(P>0.05);(4)治疗后两组组间比较,观察组总胆固醇、甘油三酯、β2微球蛋白、ALB均改善均明显优于对照组(P<0.05)。结论:高通量血液透析能降低维持性血透患者体内的炎性因子及炎性蛋白的水平,改善脂代谢过程,降低β2微球蛋白,相对于常规透析具有更好的长期效果。

Objective. To investigate and compare the efficacy of regular hemodialysis （HD） and high-flux hemodialysis （HFD） in treating patients with maintenance hemodialysis （MHD）. Methods.- A total of 60 patients with MHD were divided randomly into control group （n=30） and observation group （n=30）. Inflammatory factor, blood lipid and plasma protein levels were measured and compared before and after treatment. Results. In observation group, serum CRP, IL-6 and TNF-~ [CRP（6.84±2.12）mg/ L, IL-6 （31.20± 6.06）ng/L and TNF-α（1. 14±0.89）μg/L] were significantly decreased after undergoing dialysis （P〈0.05）, but the difference was insignificant in control group（P〉0.05）. After the treatment for 12 weeks, serum CRP, IL-6 and TNF-α were significantly lower in HFD group than that in HD group.Total cholesterol（TC）, triglyceride and plasma 132-MG levels [TC （3. 72± 0. 54）mmol/L, triglyceride （0.82±0.45）mmol/L, β2-MG （27. 54±13.49）ug/mL） were significantly decreased~ while TP[（70.12± 3.24）g/L] and ALB [-（39.20±0.68）g/L-] were significantly increased in observation group after treatment （P〈0.05）. The changes in these indexes were not significant in control group （P〉0.05）. The improve- ment in TC, triglyceride,ALB and t？2-MG in observation group were more significant than that in control group（P〈0.05）. Conclusion： HFD can decrease levels of inflammatory factors, 132-MG and inflammatory proteins,and improve lipid metabolism showing more satisfactory effects than regular hemodialysis..