血液透析、血液透析滤过与高通量血液透析治疗终末期肾脏疾病的疗效对比分析

Comparison of the efficacy of hemodialysis, hemodiafiltration and high-flux hemodialysis in the treatment of end-stage renal disease

目的 观察血液透析、血液透析滤过与高通量血液透析治疗终末期肾脏疾病（ESRD）的临床疗效.方法 205例ESRD患者按血管通路方式分为血液透析（end-stage renal disease,HD）组110例、高通量透析（high-flux hemodialysis,HFHD）组30例和血液透析滤过（hemodiafiltration,HDF）组65例,三组患者透析治疗6个月后,观察比较三组患者透析前后血液中营养指标、炎症因子指标、毒素分子及电解质指标变化情况,并记录三组患者并发症发生情况.结果 三组患者前白蛋白（PA）、血红蛋白（Hb）指标在透析后较透析前显著升高（P〈0.05）,且HFHD和HDF组Hb较CHD组显著升高（P〈0.05）,透析后尿酸（UA）、Cr、BUN指标较透析前显著改变（P〈0.05）,经两两比较发现组间差异不显著（P〉0.05）,而HFHD和HDF组患者中β2-MG、Cysc指标较透析前显著降低（P〈0.05）,经组间两两比较发现,HFHD和HDF组患者中β2-MG、Cysc指标显著低于HD组,且HDF组β2-MG、Cysc指标显著低于HFHD组（P〈0.05）.透析后三组患者血Ca2＋较透析前显著升高（P〈0.05）,而K＋、P＋均较透析前显著降低（P〈0.05）,而三组患者组间比较差异显著（P〈0.05）.透析后HFHD和HDF组患者血清中CRP、IL-6及PTH较透析前及HD患显著降低（P〈0.05）,且HDF患者血清中CRP、IL-6及PTH指标改善更加显著（P〈0.05）.三组患者并发症比较差异具有统计学意义（P〈0.05）.结论 血液透析滤过与高通量血液透析对ESRD患者血液中中、大分子清除率显著优于血液透析,且血液透析滤过对中分子物质的清除优于高通量血液透析.

Objective To observe the clinical efficacy of hemodialysis,hemodiafiltration and high-flux hemodialysis in the treatment of end-stage renal disease （ESRD）.Methods A total of 205 patients with ESRD were divided into the hemodialysis （HD） group （n =110）,high-flux hemodialysis （HFHD） group （n =30） and hemodiafiltration （HDF） group （n =65）.Changes of nutrition indexes,inflammation factors,toxin molecules and electrolyte in blood before and after dialysis were observed and compared among the three groups,and the incidence of complications was recorded.Results After dialysis,PA and Hb were significantly increased in three groups （P 〈 0.05）,and the increase of Hb was more significant in HFHD group and HDF group than CHD group （P 〈 0.05）.After dialysis,UA,Cr and BUN changed significantly （P 〈 0.05）,but there were no significant differences between groups （P 〈 0.05）.β2-MG and Cysc were significantly decreased in HFHD group and HDF group （P 〈 0.05）.The two indexes were significantly lower in HFHD group and HDF group than HD group,and significantly lower in HDF group than HFHD group （P 〈 0.05）.After dialysis,Ca2 ＋ in blood of the three groups were significantly increased （P 〈 0.05）,while K ＋ and P ＋ was significantly decreased （P 〈 0.05）,and there were significant differences among the three groups （P 〈 0.05）.After dialysis,levels of serum CRP,IL-6 and PTH in HFHD group and HDF group were significantly lower than those before dialysis and those in HD group （P 〈 0.05）,and the improvement of CRP,IL -6 and PTH was more significant in HDF group （P 〈 0.05）.There were significant differences among the three groups （P 〈 0.05）.Conclusions The medium and large molecule clearance rates in patients with ESRD and undergoing HDF and HFHD are significantly high than those in patients undergoing HD.The middle molecular substance removal by HDF is better than that of HFHD.