自动压力控制补液模式血液透析滤过对中分子物质清除效果的临床研究

Clinical study on the middle molecular toxin clearance by hemodiafiltration using the automated pressure control of convection mode

目的探讨自动压力控制模式血液透析滤过(hemodiafiltration with automated pressure control of convection mode,ULTRAc-HDF)对尿毒症患者血β_2-微球蛋白(β_2-Microglobulin,β_2-MG)、甲状旁腺激素(parathyroid hormone,PTH)等中分子毒素的清除效果。方法选择30例病情稳定的维持性血液透析患者,后稀释法输注置换液,分别给予自动压力控制补液模式血液透析滤过(ULTRAc-HDF)和容量控制补液模式血液透析滤过(volume-controlled mode,VOLc-HDF)治疗,自身交叉对照,观察不同模式下置换液量、跨膜压报警次数、凝血情况等,并比较2种模式HDF对β_2-MG、PTH等中分子物质的清除效果。结果 ULTRAc-HDF比VOLc-HDF时置换液量显著增加[(20.78±1.41)L比(18.30±0.27)L,t=9.417,P=0.000];跨膜压高压报警次数显著降低(0比16例次),高压报警发生人次的比较(χ~2=9.231,P=0.002),差异有统计学意义;透析器及管路凝血分级显著下降,透析器及管路发生凝血人次比较(χ~2=7.680,P=0.006),差异有统计学意义;ULTRAc-HDF组血PTH下降率为(57.40±4.19)%,VOLc-HDF组血PTH下降率为(51.23±6.54)%,两者对比差异有统计学意义(t=4.352,P=0.000)。ULTRAc-HDF组血β_2-MG下降率为(72.51±2.82)%,VOLc-HDF组血β_2-MG下降率为(70.81±2.93)%,两者对比差异无统计学意义(t=2.289,P=0.062),但从趋势上来分析,ULTRAc-HDF组血β_2-MG下降率较高。结论自动压力控制补液模式HDF治疗能增加置换液量,更好的清除β_2-MG、PTH等中分子物质,且可减少跨膜压高压报警次数,降低凝血风险。

Objective To investigate the effect of middle molecular toxin clearance by hemodiafiltration using the automated pressure control of convection mode （ULTRAc-HDF）. Method Thirty maintenance hemodialysis patients were enrolled in this self-control study. They were treated with ULTRAc-HDF followed by hemodiafiltration with volume-controlled mode （VOLc-HDF）, and used post-dilution convection for all patients. We investigated the convective volumes, the times of high TMP alarm and coagulation condition in different mode, and compared the clearance for blood β2-MG and PTH. Results The convection volume was significantly higher in ULTRAc-HDF mode than in VOLc-HDF mode （20.78 ± 1.41L vs. 18.30 ± 0.27L, t=9.417, P=0.000）. The number of high TMP alarm was lower in ULTRAc-HDF mode than in VOLc-HDF mode （0 vs. 16 times, χ2=9.231, P=0.002）. The prevalence of coagulation in dialyzer and dialysis tubing was significantly lower in ULTRAc-HDF mode （χ2=7.680, P=0.006）. The average PTH clearance rate was higher in ULTRAc-HDF mode than in VOLc-HDF mode （57.40±4.19% vs. 51.23±6.54%; t=4.352, P=0.000）. β2-MG decreased more in ULTRAc-HDF mode （72.51±2.82%） than in VOLc-HDF mode （70.81±2.93%） but without statistical significance （t=2.289, P=0.062）. Conclusions This study showed that the ULTRAc-HDF mode resulted in higher convection volumes and correspondingly higher clearance for β2-MG and PTH, lower risk of blood clotting, and less number of high TMP alarm.