高通量透析对维持性血液透析患者慢性并发症的影响

Effect of high-flux hemodialysis on chronic complications in patients with maintenance hemodialysis

目的探讨高通量透析对维持性血液透析患者慢性并发症的影响。方法自身对照研究35例稳定的维持性血液透析患者由低通量透析改为高通量透析1年时的临床资料,观察并比较Hb、血清白蛋白、超敏C反应蛋白、血磷、甲状旁腺激素水平,血压、降压药物使用种类变化。结果改高通量透析1年后患者Hb水平由(92.4±12.5)g/L升至(111.6±11.2)g/L(P<0.05),血清白蛋白由(36.1±2.5)g/L升至(39.5±2.8)g/L(P<0.05),超敏C反应蛋白由(8.51±1.42)mg/L降至(6.31±2.11)mg/L(P<0.05),血磷由(2.18±0.36)mmol/L下降到(1.72±0.32)mmol/L(P<0.05),甲状旁腺激素由(420.5±130.1)pg/ml下降到(210.5±108.2)pg/ml(P<0.05),透析前收缩压由原来(155.8±10.4)mmHg降为(140.3±10.2)mmHg(P<0.05),舒张压由原来(92.8±6.9)mmHg降为(83.2±4.2)mmHg(P<0.05),使用降压药种类由(3.3±1.2)种降为(1.8±1.4)种(P<0.05)。结论高通量透析较低通量透析可以更好地纠正透析患者肾性贫血、改善其营养状况、微炎症状态、增加磷、甲状旁腺激素清除,对顽固性高血压有较好控制作用,从而减少长期透析所致的各种并发症,提高患者生存质量及存活率。

Objective To investigate the effects of high-flux hemodialysis on chronic complications in patients with maintenance hemodialysis. Methods Thirty five patients with maintenance hemodialysis changed from low flux dialysis to high flux dialysis. One year after the dialysis mode change, the hemoglobin, serum albumin, hypersensitive C-reactive protein （hs-CRP） and blood phosphorus, parathyroid hormone levels, blood pressure, types of antihypertensive drugs use were documented and compared with those before change. Results One year after dialysis mode change, the hemoglobin levels were increased from （92.4 ± 12.5） g/L to （111.6 ± 11.2） g/L, serum albumin from （36.1 ± 2.5） g/L to （39.5 ± 2.8 ）g/L, hs-CRP levels were decreased from（8.51± 1.42） mg/L to（6.31 ± 2.11）/mg/L, blood phosphorus from （2.18 ± 0.36） mmol/L fell to （1.72 ± 0.32） mmol/L, parathyroid hormone from （420.5 ± 130.1） pg/ml to （210.5 ± 108.2） pg/ml; the systolic blood pressure decrease from （155.8 ± 10.4） mmHg to （ 140.3 ± 10.2 ）mmHg, diastolic blood pressure from （92.8 ± 6.9） mmHg to （83.2±4.2）mmHg, the types of antihypertensive drugs from （3.3 ± 1.2） to （1.8 ± 1.4） （all P〈0.05）. Conclusion High-flux hemodialysis can reduce or improve the chronic complications in patients with long-term maintenance hemodialysis.