HHD和HDF+HD透析疗效的临床对照研究

A controlled clinical trial of efficacy of HHD and HDF + HD

目的探讨高通量血液透析(HHD)和血液透析滤过+普通透析(HDF+HD)在慢性肾功能衰竭尿毒症患者中的应用效果。方法选择2013年8月—2014年12月间在温州康宁医院进行透析治疗的62例慢性肾衰竭尿毒症患者做观察组,并选择同期在合作单位进行透析治疗的74例慢性肾衰竭尿毒症患者作为对照组。观察组患者每周给予3次高通量透析,对照组患者每周给予1次血液透析滤过和2次普通血液透析。透析前、后,对2组患者血清中小分子毒素(血尿素、血肌酐、血尿酸、血钾、血磷)、中分子毒素(甲状旁腺激素)、大分子毒素(血β2微球蛋白、半胱氨酸蛋白酶抑制剂C)水平进行检测。透析后,对2组尿素透析充分性指标(尿素清除指数、标准蛋白质分解代谢率、时间平均尿素浓度)进行检测。通过2组数据的对比分析,对HHD和HDF+HD透析方法的临床效果进行比较。结果 2组患者透析后,各毒素的水平均出现显著性降低(P<0.05);且观察组血磷、甲状旁腺激素、半胱氨酸蛋白酶抑制剂C水平显著性低于对照组(P<0.05)。2组尿素清除指数、标准蛋白质分解代谢率、时间平均尿素浓度比较,差异无统计学意义(P>0.05)。结论相对于HDF+HD,HHD对中、大分子毒素的清除效果更好。

Objective To compare the clinical efficacy of high flux hemodialysis （HHD） and hemodiafihration （HDF） ＋ hemodialysis （HD） in the treatment of chronic renal failure with uremia. Methods A total of 62 cases of chronic renal failure with uremiatreated with hemodialysis from August 2013 to December 2014 in our hospital were enrolled into the ob- servation group, and 74 patients treated with hemodialysis in cooperative hospital in the same period were enrolledinto con- trol group. The patients in the observation group were given high flux hemodialysis（3 times each week） ;and the patients in the control group were given hemodiafiltration（ once each week） and hemodialysis （twice each week）. Before and after the hemodialysis, the small-molecular substances （ blood urea, creatinine, uric acid, potassium, phosphorus）, middle-molec- ular substances （ parathyroid hormone）, and large-molecular substances （ blood 62-micr^gl^bulin, cysteine protease inhibi- tors C） levels of two groups were observed. And after the hemodialysis, the urea dialysis adequacy indicators （ urea clear- ance index, standard protein catabolic rate, time-averaged urea concentration） of both groups were compared. The clinical efficacies of HHD and HDF ＋ HD were compared between the two groups. Results After the dialysis, the levels of all ob- served toxinsin both groups were significantly reduced（ P 〈 0.05 ） ;and levels of serum phosphorus, parathyroid hormone, cystatin C in the observation group were significantly lower than those in the control group（P 〈 0.05）. The differences in- urea clearance index, standard protein catabolic rate, time-averaged urea concentration were not significant between the two groups （ P 〉 0.05 ）. Conclusion As compared with HDF ＋ HD, HHD has better efficacy on removing the middle- and large-molecular toxins.