高通量透析治疗对尿毒症血液透析患者中低分子蛋白的清除与血脂代谢的影响

Influence of high flux dialysis on removal of low molecular protein and lipid metabolism in uremia patients undertaking hmodialysis

目的观察和评价分析高通量透析对尿毒症维持性血液透析患者中低分子蛋白的清除与血脂代谢的影响。方法选取2013年3月到2015年10月本院收治的64例终末期肾病血液透析患者，随机分为高通量透析组（HPD组）和常规血液透析组（对照组），各32例。分别于人组时、6个月、1年后采血测定患者透析前后血浆胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL—C）、尿素氮（BUN）、血肌酐（Cr）、β2微球蛋白（β2-MG）、血浆白蛋白（Alb）以及血红蛋白（Hb）；对比分析两组患者上述各项指标的变化情况。结果两组治疗方式对低分子溶质（BUN、Cr）清除差异无统计学意义（P〉0．05）；HPD组血Alb、β2-MG及Hb均较对照组明显改善；两组患者治疗后6个月、1年后，HPD组患者TC、TG、LDL—C均低于对照组，而HDL—C高于对照组，差异均有统计学意义（均P〈0．05）。结论常规血液透析对尿毒症患者的血脂紊乱无改善，且有加重作用，高通量透析可以明显改善透析患者的血脂代谢。

Objective To observe, evaluate, and analyze the influence of high flux dialysis on removal of low molecular protein and lipid metabolism in uremia patients undertaking hmodialysis. Methods 64 patients with end-stage renal disease undertaking hemodialysis treated at our hospital from March, 2013 to October, 2015 were randomly divided into an HPD group and a conventional hemodialysis group （control group）, 32 cases for each group. When being included into the study and 6 and 12 months after being included, the levels of cholesterol （TC）, triacylglycerin （TG）, high-density lipoprotein cholesterol （HDL-C）, low density lipoprotein cholesterol （LDL-C）, blood urea nitrogen （BUN）, creatinine （Cr）, beta 2 microglobulin （beta 2-MG）, plasma albumin （Alb）, and hemoglobin （Hb） before and after dialysis were detected in all the patients and compared between these two groups. Results There was no statistical difference in the clearance of BUN and Cr between these two groups （P 〉 0.05）. The levels of blood A1b, beta 2-MG, and Hb were better in the HPD group than in the control group. 6 and 12 months after the treatment, the levels of TC, TG, and LDL-C were lower and the levels of HDL-C were higher in the HPD group than in the control group, with statistical differences （P 〈 0.05）. Conclusions Routine hemodialysis cannot improve but worsen the dyslipidemia in patients with uremia without improvement. High flux dialysis can obviously improve dialysis patients＇ blood lipid metabolism.