不同血液净化方式对维持性血液透析患者血浆同型半胱氨酸的影响

Effect of different types of blood purification on clearance of homocysteine in maintenance hemodialysis patients

目的观察不同血液净化方式对维持性血液透析(MHD)患者血浆同型半胱氨酸(Hcy)的清除效果。方法选取上海市第二人民医院肾内科MHD患者70例,按随机数字表法简单随机化分为常规血液透析(HD)组24例、HD联合血液灌流(HP)组23例、血液透析滤过(HDF)组23例。分别于首次透析前后以及治疗1年后透析前采血,检测血浆Hcy浓度、血肌酐(SCr)、尿素氮(BUN),并进行统计分析比较。结果治疗前及首次透析后3组血浆Hcy组间比较,差异无统计学意义(P>0.05);首次透析前后3组血浆Hcy组内比较,差异均有统计学意义(P<0.01)。HD+HP组Hcy清除率高于HD组(P<0.01)及HDF组(P<0.05),差异有统计学意义;HDF组与HD组Hcy清除率比较,差异无统计学意义(P>0.05)。3组尿素氮下降率、单室尿素清除分数比较,差异无统计学意义(P>0.05)。治疗1年后,HD组血浆Hcy与治疗前比较,差异无统计学意义(P>0.05);HD+HP组、HDF组血浆Hcy与治疗前比较,差异均有统计学意义(P<0.01)。治疗1年后Hcy下降率比较,HD+HP组和HDF组明显高于HD组,差异均有统计学意义(P<0.05);HD+HP组与HDF组比较,差异无统计学意义(P>0.05)。结论MHD患者普遍存在高同型半胱氨酸血症,HD联合HP治疗及HDF治疗,均可有效降低MHD患者血浆Hcy浓度。

Objective To observe the effect of different types of purification on clearance of homocysteine in maintenance hemodialysis（MHD）patients.Methods A total of 70 MHD patients were randomly divided into 3 groups：regular hemodialysis group（n=24）,hemodialysis and hemoperfusion group（n=23）and hemodiafiltration group（n=23）.A series of biochemical tests were performed and compared before and after first hemodialysis and one year after hemodialysis.ResultsCompared the serum homocysteine（Hcy）before the therapy and after first hemodialysis（HD）,there was no significant difference among three groups（P〉0.05）.Before and after first hemodialysis compared the serum homocysteine,there was significant difference among three groups（P 0.01）.Clearance of homocysteine in hemodialysis and hemoperfusion（HD＋HP）group higher than in hemodialysis group（P〈0.01）and hemodiafiltration（HDF）group（PP〈0.05）.There was significant difference.Compared clearance of homocysteine in HDF group and HD group,there was no significant difference（P〉0.05）.The URR and spKt/V showed no significant difference among three group（P〉0.05）.After treatment for one year compare to the before serum Hcy in HD group showing no significant difference（P〈0.05）.Serum Hcy in HD＋HP,and HDF group significantly lower than that before treatment（P〈0.01）.The drop of Hcy in HD＋HP group and HDF group was significantly higher than in HD group（P〈0.05）.There was no significant difference between HD＋ HP group and HDF group（P〉0.05）.Conclusions Hyperhomocysteinemia is prevalent in MHD patients.Hemodialysis and hemoperfusion,as well as hemodiafiltration significantly increase the clearance of serum homocysteine.