不同血液透析方式对超敏心肌肌钙蛋白T水平的影响

Influences of Different Hemodialysis Methods on the Plasma Level of High Sensitive Cardiac Troponin T

目的:探讨低通量透析(LF-HD)、高通量透析(HF-HD)及血液透析滤过(HDF)对血浆超敏心肌肌钙蛋白T(hs-c Tn T)水平的影响。方法:选取2015年7月-2016年2月在笔者所在医院血液净化中心进行长期透析的48例患者为研究对象(试验组),随机进行LF-HD、HF-HD及HDF治疗,并同期选取健康对照组30例。试验组患者每个透析治疗模式连续进行2周,3次/周,4 h/次;透析前后(间隔2周)分别检测hs-c Tn T水平,有效浓度根据血液浓缩进行校正。结果:经LF-HD后患者hs-c Tn T有升高趋势,但差异无统计学意义(P>0.05),合并心血管病患者经LF-HD后hs-c Tn T升高,差异有统计学意义(P=0.020)。经HF-HD及HDF治疗后患者hs-c Tn T水平均降低,差异均有统计学意义(P<0.05)。结论:血液透析患者在LF-HD后hs-c Tn T水平无明显变化,而HF-HD及HDF后hs-c Tn T水平明显降低,可以掩盖因急性心肌梗死引起的心脏生物标志物的增加。

Objective：To investigate the influences of low-flux hemodialysis（LF-HD）,high-flux hemodialysis（HF-HD） and hemodialysis filtration（HDF） on the plasma level of high sensitive cardiac troponin T（hs-cTnT）.Method：Forty-eight hemodialysis（HD） patients from July 2015 to February 2016 in our hospital were included in this design as the experimental group,who were randomized to start dialysis with LF-HD,HF-HD or HDF.Each mode of dialysis lasted two consecutive weeks,three times a week,4 hours of every dialysis.The plasma levels of hs-cTnT were measured before and after dialysis,the effective values were corrected for extent of ultrafiltration.Result：After the treatment of LF-HD,the hs-cTnT tended to increase but the difference was not statistically significant（P〉0.05）,while the hs-cTnT levels increased significantly in patients with cardiovascular disease,the difference was statistically significant（P=0.020）. The levels of hs-cTnT decreased significantly after the treatment of HF-HD and HDF,the differences were statistically significant（P〈0.05）.Conclusion：Cardiac biomarker hs-cTnT levels had no statistically difference after LF-HD in HD patients,while the hs-cTnT levels decrease significantly after HF-HD and HDF, which can mask the increases of cardiac biomarker caused by myocardial infarction.