高通量透析对于维持性血液透析患者的感染风险及中长期生存状况的研究

Study of infectious risk of high-flux hemodialysis to patient with mainte-nance hemodialysis and their medium and long-term survival condition

目的探讨高通量透析对于长期血液透析患者的感染风险及中长期的生存状况。方法采用前瞻性研究方法,选取90例时间超过3个月的长期血液透析患者,随机分为三组,分别给予高通量透析（HFHD）、低通量透析（LFHD）及混合透析（LFHD＋HDF血液透析滤过）,研究时间为2012～2014年。比较三组患者中的内毒素、IL-1,IL-6及TNF-α的水平及主要终点和次要终点事件的发生率。同时测定透析用水细菌、内毒素和重金属水平的变化。结果三种透析模式在研究期间中的内毒素、IL-1、IL-6及TNF-α的水平无明显变化,差异无统计学意义（P〉0.05）。透析用水的细菌、内毒素和重金属水平均在正常范围。2012～2014年的生存率：高通量透析〉混合透析〉低通量透析。次要终点事件的发生率：高通量透析〈混合透析〈低通量透析。结论三种透析模式的感染风险无明显差异,可能主要与透析用水的质量有关,高通量透析患者的中长期生存率要高于混合透析和低通量透析患者,心血管事件的发生率高通量透析低于混合透析和低通量透析。

Objective To investigate the infectious risk of high-flux hemodialysis（HFHD） to the patients with long-term hemodialysis and their medium and long-term survival conditions. Methods A perspective research method was adopted.90 patients with long-term hemodialysis（over 3 months） were selected and randomly divided into 3 groups and respec tively given HFHD, LFHD and mixed dialysis（LFHD＋HDF） and the study duration was from 2012 to 2014. Levels of endotoxin, IL-1, IL-6 and TNF-α, together with the occurrence rate of primary and secondary endpoint events were compared. Simultaneously, the changes of levels of bacteria, endotoxin and heavy metal in the dialysis water were measured. Results The levels of endotoxin, IL-1, IL-6 and TNF-α had no obvious changes during the study with no statistical differences（P〈0.05）. Levels of bacteria, endotoxin and heavy metal in the dialysis water were within the normal ranges. 2012 to 2014 year survival rate： HFHDmixed dialysis LFHD. Occurrence rate of secondary endpoint events：HFHDmixed dialysisLFHD. Conclusion The infectious risks of three dialysis modes have no significant differences,which may be mainly because of the quality of the dialysis water. The medium and long-term survival rate of patients with HFHD is longer than patients with mixed dialysis and LFHD. Patients with HFHD have less cardiovascular events than patients with mixed dialysis and LFHD.