高通量血液透析、血液透析滤过和常规血液透析效果比较

Comparison of the effect of high-flux hemodialysis,hemodiafiltration and conventional hemodialysis

目的比较高通量血液透析(HFHD)、血液透析滤过(HDF)和常规血液透析(CHD)的效果。方法选取2012年7月至2014年2月在武穴市第一人民医院接受血液透析治疗的患者44例,按照透析治疗方法分为HFHD组(16例)、HDF组(12例)和CHD组(16例)。比较透析治疗前后3组患者血清β2-微球蛋白(β2-MG)、肌酐(Cr)、尿素(Ur)和白蛋白(ALB)水平及电解质变化。结果透析前3组患者血清β2-MG水平比较差异无统计学意义(P>0.05);CHD组患者透析前后血清β2-MG水平比较差异无统计学意义(P>0.05),HDF组和HFHD组患者透析后血清β2-MG水平均显著低于透析前(P<0.05);透析后HDF组患者血清β2-MG水平显著低于HFHD组(P<0.05)。透析前3组患者血清Cr及Ur水平比较差异均无统计学意义(P>0.05);3组患者透析后血清Cr及Ur水平均显著低于透析前(P<0.05),透析后3组患者血清Cr、Ur水平及下降率和尿素清除指数比较差异均无统计学意义(P>0.05)。透析前3组患者血清电解质水平比较差异均无统计学意义(P>0.05),3组患者透析后血清电解质水平与透析前比较差异均有统计学意义(P<0.05),透析后3组患者血清电解质水平比较差异均无统计学意义(P>0.05)。透析前、后3组患者血清ALB水平比较差异均无统计学意义(P>0.05);3组患者透析后血清ALB水平与透析前比较差异均无统计学意义(P>0.05)。结论 CHD、HFHD和HDF均能有效改善患者血清电解质紊乱,有效清除血液中的小分子物质,且不会导致蛋白质大量丢失;但HDF和HFHD清除中分子物质的效果优于CHD。

Objective To compare the effect of high-flux hemodialysis （ HFHD）, hemodiafiltration（HDF） and conven- tional hemodialysis （CHD）. Methods Forty-four patients who underwent haemodialysis in the First People＇s Hospital of W ux- ue City from July 2012 to February 2014 were divided into HFHD group（ n = 16）, HDF group（ n = 12 ） and CHD group（ n = 16 ） according to haemodialysis method. The levels of serum β2 -microglobulin （ β2-MG）, creatinine （ Cr）, urea （ Ur ）, albumin （ALB） and electrolytes were compared among the three groups before and after treatment. Results There was no significant difference in serum β2-MG level in the three groups before haemodialysis （P 〉 0.05 ）. There was no significant difference in se- rum β2-MG level before and after treatment in CHD group（ P 〉 0.05）. The level of serum β2-MG in HDF group and HFHD group after haemodialysis was significantly lower than that before haemodialysis（ P 〈 0.05 ）. The level of serum β2-MG in HDF group was significantly lower than that in HFHD group after haemodialysis （ P 〈 0.05 ）. There was no significant differenee in the levels of serum Cr and Ur in the three groups before haemodialysis（ P 〉 0. 05）. The levels of serum Cr and Ur after haemo- dialysis were significantly lower than that before haemodialysis in the three groups（ P 〈 0.05 ）. There was no significant diflbr- ence in serum Cr,Ur levels and their decrease rate, Ur clearance index in the three groups after haemodialysis （P 〉 0.05 ）. There was no significant difference in serum electrolyte levels in the three groups before haemodialysis（ P 〉 0.05 ）. There were significant differences in serum electrolyte levels before and after haemodialysis among the three groups（ P 〈 0.05 ）. There was no significant difference in serum electrolyte level among the three groups after haemodialysis （ P 〉 0.05 ）. There was no signifi- cant difference in.serum ALB level among the three groups before and after haemodialysis （ P 〉 0.05 ）. Compared with before haemodialysis,there was no significant difference in serum ALB level after haemodialysis in the three groups （ P 〉 0.05 ）. Conclusions CHD, HFHD and HDF can effectively improve the serum electrolyte disturbances, effectively remove the molec- ular substances in the blood, and not lead to the massive loss of protein. But the effect of HDF and HFHD on removing the mid-dle molecular substances is more than that of CHD.