多模式组合透析对尿毒症维持性血液透析患者氨基末端BNP、铁蛋白的影响

Effects of Multi-mode Combined Dialysis on Amino-terminal BNP and Ferritin in Uremic Maintenance Hemodialysis Patients

目的:探讨多模式组合透析对维持性血液透析(MHD)患者血氨基末端BNP、铁蛋白水平的影响。方法:采用前瞻性随机对照研究(RCT)方法,选择2016年12月-2017年12月在贵阳市第二人民医院肾内科血液净化中心接受MHD>3个月的120例慢性肾衰竭(CRF)尿毒症患者,按随机数字表法分为血液透析(HD)组(每月8次HD)、HD+血液血透滤过(HDF)组(每月8次HD+每月1次HDF)、HD+HDF+血液灌流(HP)组(每月8次HD+每月4次HDF+每月1次HP),每组40例。所有患者治疗前及治疗6、12个月后在体外循环管路静脉端采血,采用电化学发光法检测血清氨基末端BNP、铁蛋白水平。结果:120例MHD患者最终均纳入研究,无中途退出、撤出病例。三组患者治疗前血清血氨基末端BNP、铁蛋白水平比较,差异均无统计学意义(P>0.05)。与治疗前比较,三组患者治疗6、12个月后血清氨基末端BNP、铁蛋白均持续下降,且HD+HDF+HP组<HD+HDF组<HD组,差异均有统计学意义(P<0.05)。结论:多模式组合透析能降低尿毒症MHD患者体内血氨基末端BNP、铁蛋白水平,从而提高透析充分性,延长患者生命。

Objective: To investigate the effect of multi-mode combined dialysis on the levels of BNP and ferritin in the blood of maintenance hemodialysis(MHD) patients. Method: A total of 120 uremic patients with chronic renal failure(CRF) who received MHD > 3 months from December 2016 to December 2017 in the blood purification center of the department of nephrology of the Second People’s Hospital of Guiyang were selected by prospective randomized controlled study(RCT). According to the random number table, the patients were divided into hemodialysis(HD) group(8 times per month), HD + hemodiafiltration(HDF) group(8 times per month HD + 1 time per month HDF), HD + HDF + hemoperfusion(HP) group(8 times per month HD + 4 times per month HDF + 1 time per month HP), with 40 cases in each group. All patients were sampled at the venous end of extracorporeal circulation pipeline before treatment, 6 months and 12 months after treatment, and serum amino terminal BNP and ferritin levels were detected by electrochemical luminescence. Result: A total of 120 MHD patients were included in the analysis and no cases were withdrawn or withdrawn. There were no significant differences in serum levels of BNP and ferritin before entering the three groups(P>0.05). Compared with before treatment, serum amino-terminal BNP and ferritin in the three groups all decreased continuously after 6 and 12 months of treatment, and the differences between HD+HDF+HP group and HD+HDF group were statistically significant(P<0.05). Conclusion: Multi-mode combined dialysis can reduce the levels of BNP and ferritin in patients with maintenance hemodialysis of uremia, thus improving dialysis sufficiency and prolongating patients’ life.