联合应用不同血液净化技术对血液透析患者可溶性转铁蛋白受体和肾性贫血的影响

Effects of combined application of different blood purification techniques on soluble transferrin receptor and renal anemia in hemodialysis patients

目的观察联合应用不同血液净化技术对血液透析(HD)患者可溶性转铁蛋白受体(sTfR)和肾性贫血的影响。方法选择2016年1～7月于首都医科大学附属北京友谊医院治疗的维持性HD患者90例,采用随机数字表法分为HD组、HD+血液透析滤过(HDF)组、HD+血液灌流(HP)组,每组各30例。分别于HD治疗前及治疗后2、6、12个月检测各组血清sTfR水平及贫血指标,并比较治疗前后的变化值(Δ值为治疗后12个月与治疗前的差值)。结果治疗后各时间点,HD+HP组和HD+HDF组血清sTfR水平均低于HD组,治疗后6个月和12个月,HD+HP组血清sTfR水平均低于HD+HDF组,HD+HP组和HD+HDF组Δ值高于HD组,且HD+HP组高于HD+HDF组,差异均有统计学意义(或)。治疗后6个月,HD+HP组血红蛋白(Hb)和网织红细胞百分比高于HD组,血细胞比容(HCT)高于HD组和HD+HDF组,且HD+HDF组Ret%高于HD组(0.05或);治疗后12个月,HD+HP组和HD+HDF组Hb、HTC及Ret%水平均高于HD组,且HD+HP组Hb和HTC水平高于HD+HDF组,HD+HP组Hb和HTC的Δ值高于HD+HDF组和HD组,且HD+HDF组高于HD组,差异均有高度统计学意义。结论不同的血液透折方式的联合使用对维持性HD患者肾性贫血影响不同;HD+HDF或血液灌流的治疗方式较单纯HD更有利肾性贫血的改善;HD+HP在肾性贫血的改善方面更具优势。

Objective To evaluate the combined application effect of different blood purification techniques on soluble transferrin receptor（s Tf R） and renal anemia in hemodialysis patients. Methods A total of 90 patients who received the maintenance hemodialysis in Beijing Friendship Hospital Affiliated to Capital Medical University from January to July 2016 were selected, and all subjects were divided into hemodialysis group（HD group, n = 30）, hemodialysis＋hemodiafiltration group（HD＋HDF group, n = 30） and hemodialysis＋hemoperfusion group（HD＋HP group, n = 30） by number table method. Serum s Tf R levels and anemia index were detected before hemodialysis, 2, 6 months and 12 months after treatment, and the change value of before and after treatment（Δvalue=after treatment for 12 months-before treatment）were compared among the three groups. Results On different time points after treatment, the serum levels of s Tf R were lower in HD＋HDF group and HD＋HP group than that in HD group; 6 months and 12 months after treatment, the serum level of s Tf R was lower in HD＋HP group than that in HD＋HDF group; the Δ value was higher in HD＋HP group and HD＋HDF group than that in HD group, and the differences were all statistically significant（P〈0.05 or P〈0.01）. 6 months after treatment, the Hb and Ret% were higher in HD＋HDF group and HD group, the HTC was higher in HD＋HP group than in HD group and HD＋HDF group, and the Ret% was higher in HD＋HDF group than that in HD group,and the differences were all statistically significant（P〈0.05 or P〈0.01）. 12 months after treatment, the Hb, HCT and Ret% were higher in HD＋HP group and HD＋HDF group than those in HD group, and the Hb and HCT were higher in HD＋HP group than those in HD＋HDF group, the Δ value of Hb and HTC were higher in HD＋HP group than those in HD＋HDF group and HD group, and the HD＋HDF group were higher than those in HD group, and the differences were all statistically significant（P〈0.01）. Conclusion The combination of different methods of blood transfusion has different effects on renal anemia in maintenance hemodialysis patients, and the treatment of hemodialysis combined with hemodiafiltration or hemoperfusion is better than hemodialysis in the treatment of renal anemia. Hemodialysis combined with hemoperfusion has more advantages in the improvement of renal anemia.