血液透析联合血液灌流对中、大分子毒素清除与瘙痒症状疗效的观察

The removal of macro- and medial- molecular weight toxins and the alleviation of pruritus in hemodialysis combined with hemoperfusion treated uremic patients

目的观察血液透析联合血液灌流对尿毒症毒素的清除与治疗的效果。方法选择维持性血液透析（MHD）患者40例,随机分为血液透析（HD）组和血液透析联合血液灌流（HD＋HP）组,每组20例,分别对2组患者观察期治疗前后血晚期糖基化终末产物（AGEs）、同型半胱氨酸（Hcy）、甲状旁腺素（PTH）、β2-微球蛋白（β2-MG）进行测定,临床观察2组治疗对尿毒症合并顽固性瘙痒的疗效并分析测定指标的变化与合并症的变化的相关性。结果 HD＋HP组治疗12周后血AGEs、Hcy、PTH、β2-MG指标较HD组治疗12周后低,P〈0.05（依次为0.024,0.002,0.042,0.001）,HD＋HP组血AGEs、Hcy、PTH、β2-MG指标治疗后较治疗前均有下降,AGEs由759.22±227.80AU×10-3/mg降至351.17±266.58AU×10-3/mg,Hcy由26.17±7.15umol/L降至14.03±4.67umol/L,PTH由304.03±284.28pg/ml降至134.23±105.30pg/ml,β2-MG由19.51±5.70mg/L降至15.22±4.29mg/L,P〈0.05（依次为0.001,0.000,0.005,0.023）,HD组除血Hcy降低[由26.17±7.15 umol/L降至14.03±4.67umol/L（P=0.081）]外其余3项指标（血AGEs、PTH、β2-MG）治疗后均较治疗前升高,AGEs由615.56±369.06AU×10-3/mg升高至704.62±551.97AU×10-3/mg,PTH由285.30±248.94pg/ml升高至345.73±397.45pg/ml,β2-MG由19.07±4.25mg/L升高至19.45±4.68mg/L,但P〉0.05（依次为0.867,0.054,0.727）。血PTH、β2-MG降低与皮肤瘙痒症状缓解情况之间的r=0~1,P〈0.05（依次为0.045,0.037）。结论血液透析联合血液灌流能有效清除维持性血液透析患者血AGEs、Hcy、PTH、β2-MG等中大分子物质;并能有效缓解MHD患者顽固性瘙痒合并症,这与其对PTH和β2-MG的有效清除有关。

Objective To observe the effects of hemodialysis combined with hemoperfusion in uremic patients.Methods Forty maintenance hemodialysis（MHD） patients were randomly divided into hemodialysis group（HD group,n=20） or hemodialysis combined with hemoperfusion group（HD＋HP group,n=20）.Advanced glycation end products（AGEs）,homocysteine（Hcy）,parathyroid hormone（PTH）,β2-microglobulin（β 2-MG） were measured before and after the first session of the treatment,before and after the treatment for 12 weeks.Changes of itching were observed in the 2 groups.The correlation of these parameters with complications was analyzed.Results After the treatment for 12 weeks,AGEs,Hcy,PTH,and β2-MG were lower in HD＋HP group than in HD group,（P=0.024,0.002,0.042,and 0.001,respectively）.In HD＋HP group after the treatment,AGEs decreased from 759.22±227.80 AU× 10-3/mg to 351.17±266.58 AU×10-3/mg（P=0.001）,Hcy from 26.17±7.15 μmol/L to 14.03±4.67 μmol/L（P=0.000）,PTH from 304.03±284.28 pg/ml to 134.23±105.30 pg/ml（P=0.005）,and β2-MG from 19.51±5.70 mg/L to 15.22±4.29 mg/L（P=0.023）.In HD group after the treatment,however,AGEs increased from 615.56±369.06 AU×10-3/mg to 704.62±551.97 AU×10-3/mg（P= 0.867）,PTH from 285.30±248.94 pg/ml to 345.73±397.45 pg/ml（P=0.054）,β2-MG from 19.07±4.25 mg/L to 19.45±4.68 mg/L（P =0.727）,but Hcy decreased from 26.17±7.15 μmol/L to 14.03±4.67 μmol/L（P =0.081）.The correlation coefficient（r） of the alleviation of itching with the decrease of PTH and β2-MG levels was 0~ 1（P =0.045 and 0.037,respectively）.Conclusion For MHD patients,HD＋HP can efficiently remove macroand medial-size molecules,such as AGEs,Hcy,PTH and β2-MG,and remarkably improve the intractable pruritus probably relating to the clearance of PTH and β2-MG.