高通量三醋酸纤维素膜与聚砜膜透析器对维持性血液透析患者透析效果的临床研究

A clinical study on the effect of dialyzers with high-throughput cellulose triacetate membrane and polysulfone membrane for maintenance hemodialysis patients

目的比较高通量三醋酸纤维素膜(CTA)透析器与聚砜膜(PS)透析器对维持性血液透析患者的溶质清除效果、补体激活及生物相容性的影响。方法选取中国医科大学附属盛京医院第二血液净化中心2018年6—7月维持性血液透析患者60例,随机分为CTA组和PS组,每组30例。分别观察应用CTA及PS规律透析1个月后,患者血尿素氮(BUN)、肌酐(CR)、血磷、β2-微球蛋白(β2-MG)、血红蛋白(Hb)、血小板(PLT)、白细胞(WBC)、C-反应蛋白(CRP)、IgE、补体C3、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-1、IL-6等指标的变化情况,同时比较两组透析前后各指标差值。结果两组透析器对BUN、CR、血磷等小分子溶质的清除效率差异无统计学意义;两组透析器对β2-MG的清除效率差异无统计学意义;两组Hb的变化差异无统计学意义;两组透析器对WBC、CRP、C3、TNF-α、IL-1、IL-6、IgE等炎症因子的影响差异无统计学意义;PS组单次透析后有瞬时PLT下降,两组透析1个月后均无PLT下降,CTA组PLT上升较PS组明显。结论 CTA与PS对于尿毒症小分子及中分子毒素的清除作用相当,对贫血的改善无明显差异,生物相容性无差异,但CTA组对血小板影响优于PS组。

Objective To compare the effects of high-throughput cellulose triacetate membrane(CTA)dialyzer with that of polysulfone membrane(PS) dialyzer on solute clearance,complement activation and biocompatibility in maintenance hemodialysis patients(MHD). Methods A total of 60 MHD patients treated in the Second Blood Purification Center of Shengjing Hospital,China Medical University,from June to July,2018 were selected in this study. They were randomly divided into cellulose triacetate membrane group(CTA group)and polysulfone membrane group(PS group),30 cases in each group. Respectively observe the clanges in BUN,CR,P,β2-MG,Hb,PLT,WBC,CRP,IgE,C3,TNF-α,IL-1 and IL-6;at the same time compare the difference between the two groups before and after dialysis. Resluts There was no statistically significant difference in the clearance of BUN,CR,P or β2-MG between the two groups. There was no difference in the change of Hb between the two groups. The effect on WBC,CRP,C3,TNF-α,IL-1,IL-6 and IgE had no statistical difference between the two groups. In PS group,there was transient platelet decline after one time of dialysis,and there was no platelet decline after 1 month of dialysis in both groups. The platelet rise in CTA group was more obvious than that in PS group. Conclusion The two dialyzers(CTA and PS)have the same effect on the clearance of small and medium molecular toxins in uremia;there was no significant difference in the improvement of anemia,and no difference in biocompatibility. However,the effect of CTA group on platelet was better than that of PS group.