高通量血液透析对维持性血液透析患者左心室结构和功能的影响

Effects of high flux hemodialysis on left ventricular structure and function in maintenance hemodialysis patients

目的观察高通量血液透析(high-flux hemodialysis,HFHD)对维持性血液透析(maintenance hemodialysis,MHD)患者左心室结构和功能的影响,并探讨其可能的机制。方法采用前瞻性、自身对照研究。88例常规MHD患者,转换为HFHD治疗24个月。于HFHD治疗前(0个月)、治疗12个月及治疗24个月后,采用超声心动图分别测定左心房、左心室的结构和功能,并抽取静脉血检测患者的临床指标。结果转换为HFHD组患者在治疗12个月时,心功能指标LAD、LVPWT、IVST、LVEF、E/A与治疗前比较差异无统计学意义;LVDd、LVMI与治疗前比较,差异有统计学意义(P<0.05);在治疗24个月时,LAD、LVDd、LVPWT、LVEF与治疗前比较,差异有统计学意义(P<0.05)。经HFHD治疗24个月后,血清ALB、CH、TG、HDL、LDL、Scr、BUN、hs-CRP、DBP、MAP与治疗前比较无明显变化,Hb、Ca与治疗前比较明显升高(P<0.05),而P、iPTH、β2-MG较治疗前明显降低(P<0.05)。结论尿毒症患者普遍存在左心室肥厚。HFHD治疗虽然清除了PTH、β2-MG等中大分子毒素,改善了贫血,但并不能阻止MHD患者左心室舒张功能的进一步恶化。

Objective To investigate the effects of high flux hemodialysis on cardiac structure and function in maintenance hemodialysis patients, and to study the possible mechanism. Methods The study was prospective and self-controlled. A totol of 88 pa- tients on maintainance low flux hemodialysis were recruited, after changing to a high flux hemodialysis treatment for 24 months. Their cardiac structure and function were compared by echocardiography respectively. Serum creatinine（SCr）, blood urea nitrogen（ BUN）, serum phosphorus （ P）, calcium （ Ca）, intact parathyroid hormone （ iPTH ）, 132 - mim＇oglobulin （ 132 -MG） , high sensitivity C-reactive protein（hs-CRP）, albumin （ALB）, and hemoglobin （Hb） levels were determined after the switch for O, 12 and 24 months. Results There was no significant atteration of the cardiac function indexes of LAD, LVPWT, IVST, LVEF, E/A, compared with be- fore alter 12 months＇ treatment of HFHD. But patients with HDHF on treatment for 24 months, had significant alteration of the cardiac function indexes of LAD, LVDd, LVPWT, IVST, LVEF compared with before （P 〈0.05）. In patients with HDHF on the treatment for 24 mnnths, the clinical indicators of serum ALB, CH, TG, HDL, LDL, Scr, BUN, hs-CRP, DBP, MAP had no differences before and after changing to HFHD, serum Hb and Ca significantly increased after changing to HFHD （ P 〈 0.05） , serum P, iPTH, 132-MG have significantly decreased after changing to HFH D（ P 〈 O. 05 ）. Conclusions In MHD patients universally exists left ventricular hy- pertrophy. Although HFHD may remove plasma medium molecule and macromolec.ule toxins such as 132-MG, inflammation substance and improve uremia in the body, it can not improve left ventricular diastolic function.