维持性血液透析患者应用不同血液净化方式对残余肾功能影响的临床研究

The impact of different blood purification methods on the residual renal function among maintenance hemodialysis patients

目的 探讨维持性血液透析患者应用不同的血液净化方式对残余肾功能（RRF）的影响.方法 将西峡县人民医院收治的144例需行常规血液透析的尿毒症患者随机分为A[高通量血液透析（HFHD）]、B[低通量血液透析（LFHD）]、C[血液透析联合血液灌注（HD＋HP）]三组,每组48例.分别治疗6个月,比较三组患者治疗前后RRF、三酰甘油、β2微球蛋白、胆固醇和血磷浓度的变化情况.结果 透析前三组患者的各项指标比较差异均未见统计学意义（P＞0.05）,治疗后三组患者的RRF均显著降低（P＜0.05）,但A、C两组下降程度明显小于B组,差异有统计学意义（P＜0.05）.A、C两组治疗后三酰甘油、β2微球蛋白、胆固醇和血磷浓度水平也明显低于治疗前和B组,差异有统计学意义（P＜0.05）.结论 不同的血液净化方式均会使维持性血液透析患者的RRF下降,但与LFHD比较,HFHD和HD＋ HP的RRF下降幅度更小,因而具有更好的RRF保护作用,同时还能降低患者的血脂、血磷和β2微球蛋白水平.

Objective To study the impact of different blood purification methods on the residual renal function（RRF） among maintenance hemodialysis patients.Methods A total of 144 cases with uremia in Xixia People＇s Hospital were chose.They were randomly divided into three groups,group A [high-flux hemodialysis （HFHD）],group B [low-flux hemodialysis （LFHD）] and group C [hemodialysis combined hemoperfusion（HD ＋ HP）],respectively treated all patients for 6 months,then the before and after change of RRF,triacylglycerol,β2-microglobulin,cholesterol and serum phosphate levels of three groups patients were compared.Results RRF,triacylglycerol,β2-microglobulin,cholesterol and serum phosphate levels had no significant difference among the three groups （P 〉 0.05） before the treatment.After the treatment,RRF was significantly lower than that before the treatment in the three groups （P 〈 0.05）,but it was significantly different among the three groups（P 〈 0.05）.Triacylglycerol,β2-microglobulin,cholesterol and serum phosphate levels of group A and group C after the treatment became significantly lower than those of group B and those before the treatment （P 〈 0.05）.Conclusions RRF declined in hemodialysis patients after dialysis.But compared with LFHD,the decline rate of HFHD and HD ＋ HP was lower,suggesting that HFHD and HD ＋ HP were better to protect RRF than LFHD,and they both can reduce the blood lipids,serum phosphate levels and β2-microglobulin in hemodialysis patients.