高通量血液透析对终末期肾病患者心功能的影响

Effect of high-flux hemodialysis on cardiac function in patients with end-stage renal disease

目的探讨高通量血液透析对终末期肾病患者心功能的影响。方法选择2015年1月至2016年12月于开封市中心医院进行维持性血液透析的终末期肾病患者62例,按照随机数字表法分为高通量血液透析组和常规血液透析组,每组各31例。比较两组患者治疗后6个月的心肌损伤(心肌肌钙蛋白、B型脑钠肽、血清肌酐、尿素氮、甲状旁腺激素)和心功能指标[左心室舒张期末内径(LVEDd)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室射血分数(LVEF)、舒张早期与晚期最大血流比(E/A)、左心室重量指数(LVMI)]的变化。结果高通量血液透析组透析后甲状旁腺激素、心肌肌钙蛋白T、B型脑钠肽低于常规血液透析组,差异有统计学意义(P<0.05)。高通量血液透析组透析后IVST、LVPWT、LVMI低于常规血液透析组,LVEF高于常规血液透析组,差异有统计学意义(P<0.05)。结论高通量血液透析可以有效清除甲状旁腺激素,相较于常规血液透析,在改善终末期肾病患者心功能方面具有一定优势。

Objective To investigate the effect of high-flux hemodialysis（ HFHD） on cardiac function in those patients with end-stage renal disease（ ESRD）. Methods A total of 62 patients with ESRD underwent maintenance hemodialysis（ MHD） in our hospital between Jan 2015 and Dec 2016 were selected,and then divided into the HFHD group and the conventional hemodialysis group by means of random number table,31 cases in each group. Changes of myocardial injury biomarkers（ levels of cardiac troponin,B-type natriuretic peptide,serum creatinine,urea nitrogen,parathyroid hormone） and cardiac function parameters [left ventricular end-diastolic diameter（ LVEDd）,interventricular septal thickness（ IVST）,left ventricular posterior wall thickness（ LVPWT）,left ventricular ejection fraction（ LVEF）,ratio of early diastolic to advanced diastolic peak blood flow（ E/A）,left ventricular mass index（ LVMI） ]between the two groups were compared after treating for 6 months. Results The levels of parathyroid hormone,cardiac troponin T and B-type natriuretic peptide after dialysis in the HFHD group were significantly lower than those in the conventional dialysis group（ P〈0. 05）. The values of IVST,LVPWT and LVMI after dialysis in the HFHD group were much lower than those in the conventional dialysis group,but the LVEF value in the HFHD group was much higher than that in the conventional dialysis group,and the differences between them were statistically significant（ all P〈0. 05）. Conclusion Application of HFHD could effectively remove parathyroid hormones,and may have certain advantages over conventional hemodialysis in the improvement of cardiac function for those ESRD patients.