不同血液净化方式对尿毒症患者血液中中、大分子毒素清除的效果比较

Comparison of the effects of different blood purification methods on removal of macromolecules in uremia

目的 比较不同血液净化方式对维持性血液透析（MHD）患者血液中中、大分子毒素清除效果,为临床选择适宜透析方式预防或者延缓尿毒症患者的远期并发症提供临床依据.方法 选取长期、稳定常规透析的MHD患者60例,且均有中、大分子毒素透析不充分等情况者.采取随机数字表法将60例患者分为高通量血液透析（HFHD）组和血液透析滤过（HDF）组,每组30例,并于研究前、3个月和6个月后分别检验透析前、透析后的血清甲状旁腺素（PTH）、β2微球蛋白（β2-MG）及胱抑素C（Cys-C）.结果 PTH清除方面,HFHD组[（286.34±127.33）pg/mL]相比HDF组[（376.04±141.74）pg/mL]增加明显,两组差异有统计学意义（t=2.45,P〈0.05）;对于β2-MG的清除方面,HDF组[（11.34±1.96）mg/L]比HFHD组[（15.41±3.02）mg/L]增加明显,两组差异有统计学意义（t=5.88,P〈0.05）;对于Cys-C清除方面,HFHD组[（263.67±98.72）μg/dL]比HDF组[（345.63±105.00）μg/dL]增加更明显,两组差异有统计学意义（t=2.96,P〈0.05）.结论 两种透析方式都非常有效地清除患者血液中中、大分子尿毒症毒素;在清除患者血液中增多的PTH方面,HFHD更有效;在清除患者血液中增多的β2-MG方面,HDF更有效;在清除Cys-C方面,HFHD效果更佳.

Objective To compare the effects of different blood purification methods on the removal of large and medium molecular toxins in patients with maintenance hemodialysis（MHD）, and to provide the clinical basis for selecting suitable dialysis modalities to prevent or delay the long term complications of uremic patients.Methods60 MHD patients with long term and stable hemodialysis were enrolled in this study.All of them were selected from the patients with insufficient hemodialysis.According to the digital table,60 patients were randomly divided into high flux hemodialysis （HFHD）group and hemodiafiltration （HDF） group,30 cases in each group.And before,3 months and 6 months after dialysis, the serum β2-MG,PTH and Cys C after dialysis were tested.Results The clearance of PTH in the HFHD group[（286.34±127.33）pg/mL] was significantly higher than that in the HDF group[（376.04±141.74）pg/mL],the difference was statistically significant（t=2.45,P〈0.05）.The clearance of β2-MG in the HDF group[（11.34±1.96）mg/L]was significantly higher than that in the HFHD group[（15.41±3.02）mg/L],the difference was significant（t=5.88,P〈0.05）.The clearance of Cys C in the HFHD group[（263.67±98.72）μg/dL]was significantly higher than that in the HDF group[（345.63±105.00）μg/dL],the difference was statistically significant（t=2.96,P〈0.05）.Conclusion Both two dialysis methods are very effective in the removal of large and medium molecular uremic toxins in patients.In the removal of patients with increased PTH,HFHD is more effective.In the removal of patients with increased β2-MG,HDF is more effective.In the removal of Cys C,HFHD is better.