两种血液净化方法对2型糖尿病终末期肾病维持血液透析患者血清β_2-微球蛋白及甲状旁腺素的影响

Effects of Two Blood Purification Techniques on β_2-Microglobulin and Parathyroid Hormone in Type 2 Diabetic Patients with End Stage Renal Disease of Maintenance Hemodialysis

目的比较杂合肾脏替代疗法及间断血液透析治疗对2型糖尿病终末期肾病维持血液透析患者血清β2-微球蛋白(β2-Microglobulin,β2-MG)及甲状旁腺素(parathyroid hormone,PTH)的清除水平。方法选择2015年3月至2016年8月我院血液透析中心符合入选标准的40例患者,分为杂合肾脏替代治疗(heterozygous renal replacement therapy,HRRT)组及间断血液透析治疗(intermittent hemodialysis,IHD)组,每组均为20例。在治疗前、治疗4个月、8个月及12个月后分别抽血,用胶乳增强散射免疫比浊法检测其血清β2-MG水平,并用化学发光法测PTH水平。结果治疗前HRRT组及IHD组血清β2-MG及PTH水平比较无统计学意义(P>0.05),连续治疗4个月、8个月、12个月后HRRT组血清β2-MG及PTH水平均明显低于IHD组,均具有统计学意义(P<0.05)。结论杂合肾脏替代疗法对中分子清除有效,长期应用可有效缓解患者皮肤瘙痒,并显著提高患者生活质量及生存率。

Objective To compare hybrid renal replacement therapy and intermittent hemodialysis diabetic nephropathy on the performance of removing β2-microglobulin and parathyroid hormone in type 2 diabetic patients with end stage renal disease of maintenance hemodialysis. Methods We chose 40 patients conforming to the criteria in our hemodialysis center then divided them into hybrid renal replacement therapy and intermittent hemodialysis diabetic nephropathy groups randomly,with 20 patients in each group. We then collected blood samples with immune turbidimetric method to measure β2-microglobulin levels in the serum,also with chemiluminescence immunoassay method to measure levels of parathyroid hormone in the pretreatment condition,4 months,8 months,12 months after the treatment conditions. Results Theβ2-microglobulin and PTH levels had no statistical difference（ P〈0. 05） in HRRT and IHD groups before treatment. 4 months,8 months,and 12 months after the treatment,the β2-microglobulin and PTH levels are significantly lower in the hybrid renal replacement therapy group than the group of intermittent hemodialysis diabetic nephropathy. Conclusion Hybrid renal replacement therapy is effective to remove the middle size molecule. Among patients with long-term application of HRRT,it can effectively relieve itch,and improve patient＇s life quality and survival rate significantly.