高通量血液透析治疗慢性肾衰竭尿毒症的疗效及对尿毒症毒素、免疫球蛋白及肺功能指标的影响

Therapeutic Effect of High Flux Hemodialysis on Chronic Renal Failure Uremia and Its Influence on Uremic Toxin, Immunoglobulin and Pulmonary Function

目的:探讨高通量血液透析(HFHD)治疗慢性肾衰竭尿毒症的疗效及对尿毒症毒素、免疫球蛋白及肺功能指标的影响。方法:选取90例于2012年1月-2017年3月期间在喀什地区第一人民医院治疗的慢性肾衰竭尿毒症患者,依据随机数字表法将其分为对照组(n=45)和观察组(n=45),对照组给予血液透析滤过(HDF)治疗,观察组给予HFHD治疗,两组均透析治疗1个月。对比两组患者透析前后症状缓解情况及尿毒症毒素、免疫球蛋白及肺功能指标水平,记录两组相关并发症的发生情况。结果:透析治疗结束后观察组患者缓解率为91.11%(41/45),高于对照组的73.33%(33/45)(P<0.05)。两组患者透析后血磷(P-)、血钾(K+)、甲状旁腺激素(PTH)、β2-微球蛋白(β2-MG)水平明显低于透析前,血钙(Ca2+)水平明显高于透析前(P<0.05);观察组透析后K+、Ca2+、P-等尿毒症毒素水平与对照组比较差异无统计学意义(P>0.05),观察组透析后PTH、β2-MG水平明显低于对照组(P<0.05)。透析后,两组患者的免疫球蛋白Ig M、Ig A、Ig G水平均较透析前上升,且观察组高于对照组(P<0.05)。透析后,两组患者残气量(RV)均低于治疗前,最大肺活量(FVC)、肺活量(VC)、肺总量(TLC)均高于治疗前,且观察组RV低于对照组,FVC、VC、TLC均高于对照组(P<0.05)。观察组并发症发生率为8.89%(4/45),低于对照组的24.44%(11/45)(P<0.05)。结论:HFHD治疗慢性肾衰竭尿毒症能够安全有效地清除尿毒症毒素,缓解患者的临床症状,且能够提高患者的免疫功能和肺功能。

Objective: To explore the effect of high flux hemodialysis(HFHD) on chronic renal failure uremia and its influence on uremic toxin, immunoglobulin and pulmonary function index. Methods: A total of 90 uremic patients with chronic renal failure, who were admitted to the First People’s Hospital of Kashgar from January 2012 to March 2017, were selected and were randomly divided into control group(n=45) and observation group(n=45). The control group was treated with hemodiafiltration(HDF), the observation group was treated with HFHD. Both groups were treated with dialysis for one month. The remission of symptoms and the levels of uremic toxin, immunoglobulin and pulmonary function indexes before and after dialysis were compared between the two groups. The occurrence of related complications were recorded. Results: The remission rate of observation group was 91.11% after dialysis treatment,which was higher than 73.33% in the control group(P<0.05). The levels of serum phosphorus(P-), potassium(K+), parathyroid hormone(PTH) andβ2-microglobulin(β2-MG) in the two groups after dialysis were significantly lower than those before dialysis. The level of serum calcium(Ca2+) was significantly higher than that before dialysis(P<0.05). There were no significant differences in the levels of K+, Ca2+, Pand other uremic toxins between the observation group and the control group after dialysis(P>0.05). The levels of PTH and β2-MG in the observation group after dialysis were significantly lower than those in the control group(P<0.05). After dialysis, the levels of Ig M,Ig A and Ig G in the two groups were higher than those before dialysis, the observation group was higher than the control group(P<0.05).After dialysis, the residual air volume(RV) in both groups was lower than that before treatment, and the maximum vital capacity(FVC),vital capacity(VC) and total lung volume(TLC) were higher than those before treatment, and the RV in the observation group was lower than that in the control group, the FVC, VC and TLC were higher than those of the control group(P <0.05). The incidence of complications in the observation group was 8.89%(4/45), which was lower than 24.44% in the control group(P<0.05). Conclusion:HFHD, in the treatment of patients with chronic renal failure uremia, can remove uremic toxin safely and effectively, alleviate clinical symptoms, and improve immune function and lung function of patients.