联机和高通量血液透析单独与贯序应用对于终末期肾病患者透析充分性和生活质量的影响

The effects of on-line and high-flux hemodialysis alone and sequential application on dialysis adequacy and quality of life in patients with end-stage renal disease

目的研究联机血液透析滤过(on-line HDF)和高通量血液透析(HFHD)单独与贯序应用对于终末期肾病(ESRD)患者透析充分性和生活质量的影响。方法选取该院2017年1月到2018年1月间收治的ESRD患者102例,采用随机数字法将其分为HFHD组、on-1ine HDF组、HFHD+on-line HDF序贯组(序贯组),每组34例。3个月后比较3组患者治疗前、后肾功能指标[包括血尿素氮(BUN)、血肌酐(Scr)、血尿酸(BUA)、β_2微球蛋白(β_2-MG)等],透析充分性指标[包括尿素清除率(Kt/v)、尿素氮下降率(URR)、β_2-MG清除率等],血清学指标[包括血钙(Ca^(2+))、血磷(P^(3+))、甲状旁腺素(PTH),微炎症指标C反应蛋白(CRP)、白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)]及生活质量评分。结果治疗前,3组患者的肾功能指标、透析充分性指标、血清学指标及健康调查简表(SF-36)评分差异无统计学意义(P>0.05);治疗后,序贯组患者肾功能指标BUN(7.89±1.02)mmol/L、BUA(210.56±24.96)mmol/L、Scr(230.21±20.21)μmol/L、β_2-MG(8.02±1.27)mg/L,微炎症指标CRP(0.27±0.14)mmol/L、IL-6(10.01±5.24)mmol/L、TNF-α(1.03±0.52)mg/mL,血清学指标P^(3+)(0.70±0.21)mmol/L、PTH(0.9±0.25)pg/L,均明显低于HFHD组、on-1ine HDF组(P<0.05);透析充分性指标Kt/v 66.35%、URR78.65%、β_2-MG清除率79.66%。血清学指标Ca^(2+)(0.7±0.11)mmol/L、SF-36评分128.94分,均明显高于HFHD组、on-1ine HDF组(P<0.05)。结论 on-line HDF和HFHD序贯应用治疗ESRD疗效显著,可改善患者肾功能,提高生活质量,减轻患者炎性反应,值得在临床推广应用。

Objective To investigate the effects of on-line hemodiafiltration and high-flux hemodialysis alone or sequential application on dialysis adequacy and quality of life in patients with end-stage renal disease.Methods Twenty-two patients with end-stage renal disease who were admitted to this hospital from January 2017 to January 2018 were randomly selected and divided into the high-flux hemodialysis group(HFHD group)and the on-line hemodiafiltration group(on-1ine HDF),the high-flux hemodialysis+on-line hemodiafiltration sequential group(HFHD+on-1ine HDF sequential group),34 cases in each group.After three months,the renal function indexes[including blood urea nitrogen(BUN),serum creatinine(Scr),serum uric acid(BUA),β2 microglobulin(β2-MG),etc.),dialysis adequacy indexes(including urea clearance rate(Kt/v),urea reduction rate(URR),β2-MG clearance rate),serological markers(including serum calcium(Ca^2+),serum phosphorus(P^3+),parathyroid hormone(PTH),micro-inflammatory markers C-reactive protein(CRP),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)and quality of life scores before and after treatment were compared among the three groups of patients.Results Before treatment,there were no significant differences in renal function index,dialysis adequacy index,serological index and health survey summary(SF-36)scores among the three groups(P>0.05).After treatment,the BUN was(7.89±1.02)mmol/L,BUA was(210.56±24.96)mmol/L,Scr was(230.21±20.21)μmol/L,β2-MG was(8.02±1.27)mg/L,microinflammation index CRP protein was(0.27±0.14)mmol/L,IL-6 was(10.01±5.24)mmol/L,TNF-αwas(1.03±0.52)mg/mL,serum index P^3+was(0.70±0.21)mmol/L,PTH was(0.9±0.25)pg/L in the HFHD+on-1ine HDF sequential group,which were significantly lower than the HFHD group and the on-1ine HDF group(P<0.05);dialysis adequacy index Kt/v(66.35%),URR(78.65%),β2-MG clearance rate(79.66%),Ca^2+[(0.7±0.11)mmol/L],the score of SF-36(128.94 scores)were significantly higher than that in the HFHD group and the on-1ine HDF group(P<0.05).Conclusion The combination of on-line hemodiafiltration and high-flux hemodialysis sequential hemodialysis has a significant effect on the treatment of end-stage renal disease.It can improve the renal function and the quality of life,reduce the patient′s inflammatory response.It is worthy of clinical application.