血液灌流对维持性血液透析患者蛋白结合类毒素清除及生活质量的影响

Effect of hemoperfusion on the clearance of protein bound uremic toxins and the quality of life in maintenance hemodialysis patients

目的观察长期血液透析(hemodialysis,HD)联合血液灌流(hemoperfusion,HP)治疗对维持性血液透析(maintenance hemodialysis,MHD)患者体内蛋白结合类毒素的清除效果及对生活质量的影响。方法选取MHD患者36例,分为HD+HP组、HD组,每组各18例,HD+HP组HD治疗每周2次,HD+HP每周1次,HD组HD治疗每周3次,共36周。对比分析研究前后蛋白结合类毒素马尿酸(hippuric acid,HA)、硫酸吲哚酚(indoxyl sulphate,IS)、硫酸对甲酚(p-cresyl sulphate,PCS)的浓度变化及尿素氮清除指数(Kt/V)变化。同时采用肾脏病生活质量简表(kidney disease and quality of life-short form,KDQOL-SF1.3)进行生活质量评估。结果 (1)HA、PCS研究前、后比较,HD组无统计学差异(t=-0.328,P=0.747;t=-0.178,P=0.861);HD+HP组明显下降(t=2.221,P=0.040;t=2.207,P=0.041);研究结束时组间比较HD+HP组明显低于HD组(t=2.139,P=0.045;t=2.051,P=0.048);(2)IS研究前、后比较,HD组明显上升(z=-2.298,P=0.035),HD+HP组无统计学差异(z=-0.970,P=0.332),研究结束时组间比较无明显差异(z=-1.485,P=0.137);(3)生活质量研究前、后比较,HD组躯体疼痛、精力维度得分较基线明显降低(t=2.136,P=0.049;t=2.947,P=0.009);HD+HP组症状与不适、肾病影响、精力维度得分较基线明显升高(t=-2.345,P=0.032;t=-2.467,P=0.025;t=-2.315,P=0.034)。HD+HP组治疗后肾病影响、认知功能、睡眠质量、生理机能、躯体疼痛、总体健康、社会功能、精力明显好于HD组(t=-2.111,P=0.043;t=2.051,P=0.049;t=-2.062,P=0.047;t=-2.241,P=0.032;t=-2.122,P=0.042;t=-2.374,P=0.024;t=-2.110,P=0.043;t=-2.560,P=0.015)。结论长期使用HD+HP治疗对MHD患者体内蛋白结合毒素的清除效果优于HD治疗,并且可明显改善MHD患者的生活质量。

Objective To observe the effect of long-term hemodialysis （HD） combined with hemoperfu- sion （HP） on the clearance of protein bound uremic toxins and the quality of life in maintenance hemodialysis （MHD） patients. Methods A total of 36 MHD patients were randomly and equally divided into HD and HD＋ HP groups. Patients in HD group were treated with low-flux hemodialysis three times a week, while those in HD＋HP group were treated with low-flux hemodialysis twice a week and hemodialysis combined with herao- perfusion once a week. They were followed up for 36 weeks. Urea clearance index （Kt/F） and the concentra- tions of protein bound uremic toxins including hippuric acid （HA）, indoxyl sulphate （IS） and p-cresyl sulphate （PCS） were compared before and after the treatment. The Kidney Disease Quality of Life Short Form （ KDQOL-SF1.3） scale was used to assess the quality of life. ResuLt OAfter the treatment for 36 weeks, HA and PCS had no statistical significances in HD group （HA： t=-0.328, P=0.747; PCS： t=--0.178, P=0.861） but decreased significantly in HD＋HP group （HA： t=-2.221, P=0.040; PCS： t=2.207, P=0.041） as compared with those before the treatment. HA and PCS were significantly lower in HD＋HP group than in HD group （HA： t= 2.139, P=0.045; PCS： t=-2.051, P=0.048） at the end of the study. （2）After the treatment for 36 weeks, IS was significantly higher （z=-2.298, P=0.035） in HD group but had no statistical difference in HD＋HP group （z=- 0.970, P=0.332） as compared with that before the treatment. IS had no significant difference between the two groups （z=-1.485, P=0.137） at the end of the study. ③After the treatment for 36 weeks, bodily pain and vitali- ty scores, the two parameters of quality of life, were significantly lower in HD group （bodily pain： t=2.136, P= 0.049; vitality： t=-2.947, P=0.009）, while dialysis related symptoms, effects of kidney disease and vitality scores were significantly higher in HD＋HP group （dialysis related symptoms： t=-2.345, P=0.032; effects of kidney disease： t=-2.467, P=0.025; vitality： t=-2.315, P=0.034） as compared with those before the treatment. The effects of kidney disease, cognitive function, sleep, physical function, bodily pain, general health, social function and vitality scores were better in HD＋HP group than in HD group （effects of kidney disease： ^- 2.111,/=0.043; cognitive function： t=2.051, P=0.049; sleep： t=-2.062, P=0.047; physical function： t=-2.241, P=0.032; bodily pain： t=-2.122, P=0.042; general health： t=-2.374, P=0.024; social function： t=-2.110, P= 0.043; vitality： t=-2.560, P=0.015）. Conclusion Long-term use of HD＋HP is better than conventional HD in the removal of protein bound uremic toxins and the improvement of quality of life in MHD patients.