不同透析方式对维持性血液透析患者尿素氮、肌酐、血磷和β2-微球蛋白清除的影响

Effects of different dialysis methods on clearance of urea nitrogen, creatinine, phosphorus, and β2-microglobulin in patients with maintenance hemodialysis

目的探究不同透析方式对维持性血液透析患者尿素氮(BUN)、肌酐(Scr)、血磷(P)和β2-微球蛋白(β2-MG)清除的影响。方法选取2018年3~11月间在西安市第九医院肾脏内科行血液透析治疗的118例患者作为研究对象,根据患者或家属意愿将患者分为普通透析组(HD组)30例,透析滤过组(HDF组)44例和血液透析联合血液灌流组(HD+HP组)44例。比较三组患者治疗前及治疗三个月后血液中BUN、Scr、P和β2-MG的变化情况。结果HDF组患者治疗后的BUN、Scr、P水平分别为(24.51±4.55)mmol/L、(315.89±42.92)mol/L、(1.52±0.23)mmol/L,HD+HP组分别为(24.08±4.69)mmol/L、(312.46±43.18)mol/L、(1.55±0.26)mmol/L,均明显低于HD组的(31.34±5.62)mmol/L、(423.37±62.01)mol/L、(2.25±0.36)mmol/L,差异均有统计学意义(P<0.05);HDF组和HD+HP组患者的BUN、Scr、P水平比较差异均无统计学意义(P>0.05);HDF组患者治疗后的β2-MG水平与β2-MG清除率分别为(16.39±2.47)g/dL、(29.87±7.03)%,HD+HP组分别为(15.28±2.42)g/dL、(35.17±11.76)%,HD组分别为(22.73±2.72)g/dL、(1.77±6.12)%,HDF组和HD+HP组的β2-MG水平低于HD组、而β2-MG清除率高于HD组,差异均有统计学意义(P<0.05);HDF组与HD+HP组患者的β2-MG、β2-MG清除率比较差异也具有统计学意义(P<0.05)。结论三种透析方式均能清理小分子毒素BUN、Scr和P,但HDF和HD+HP的效果更为显著,对于中分子毒素β2-MG,传统HD无明显效果,选择HDF或HD+HP的透析方式才能有效清除,其中,HD+HP的效果最为显著。

Objective To explore the effects of different dialysis methods on the clearance of blood phosphorus(P)and β2-MG in patients with maintenance hemodialysis by urea nitrogen(BUN),creatinine(Scr),and β2-microglobulin(β2-MG).Methods A total of 118 patients who underwent hemodialysis in the Department of Nephrology,the Ninth Hospital of Xi'an City from March 2018 to November 2018 were selected as the study subjects.With the consent of the patients and their families,the patients were divided into the general dialysis group(HD group,n=30),dialysis filtration group(HDF group,n=44)and hemodialysis combined with hemoperfusion group(HD+HP group,n=44)according to the wishes of the patients or their families.The changes of BUN,Scr,P and β2-MG in blood of the three groups before and after three months of treatment were compared.Results The levels of BUN,Scr,P in the HDF group and HD+HP group after treatment were(24.51±4.55)mmol/L,(315.89±42.92)mol/L,(1.52±0.23)mmol/L and(24.08±4.69)mmol/L,(312.46±43.18)mol/L,(1.55±0.26)mmol/L,respectively,which were significantly lower than corresponding(31.34±5.62)mmol/L,(423.37±62.01)mol/L,(2.25±0.36)mmol/L in HD group(all P<0.05).There was no significant difference in the levels of BUN,Scr,P between HDF group and HD+HP group(all P>0.05).The level and clearance rates of β2-MG in the HDF group,HD+HP group and HD group were(16.39±2.47)g/dL and(29.87±7.03)%,(15.28±2.42)g/dL and(35.17±11.76)%,(22.73±2.72)g/dL and(1.77±6.12)%,respectively.The level of β2-MG in the HDF group and HD+HP group was significantly lower than those of the HD group,while the clearance rate of β2-MG was significantly higher than those of HD group(all P<0.05).There were significant differences in the clearance rate of β2-MG between the HDF group and HD+HP group(all P<0.05).Conclusion The three dialysis methods are effective to clean up the small molecular toxin BUN,Scr and P,HDF and P,respectively.The effect of HDF and HD+HP is more obvious.Traditional HD has no obvious effect on molecular toxinβ2-MG,which can be only cleaned up by the dialysis mode of HDF or HD+HP,and HD+HP is the most effective.