不同血液透析模式对维持性血液透析患者透析充分性和营养状况及心血管相关指标的影响

The effect of different hemodialysis modes on the dialysis adequacy,nutritional status and cardiovascular related indicators of maintenance hemodialysis patients

目的探讨血液透析、血液透析滤过(HDF)和血液灌流3种不同透析模式对维持性血液透析患者透析充分性、营养状况以及心血管相关指标的影响。方法选取2017年6月至2018年6月就诊于新疆医科大学第一附属医院肾病中心的维持性血液透析患者171例,根据不同的治疗模式分为血液透析组(HD组,57例)、HDF组(57例)、血液灌流组(HP组,57例)。HD组患者仅行血液透析治疗;HDF组行血液透析+血液透析滤过治疗;HP组行血液透析+血液灌流治疗。比较3组透析前以及透析3个月后的血压、血钙、血磷、C反应蛋白(CRP)、甲状旁腺激素(PTH)、血尿素氮、血肌酐、血红蛋白、白蛋白、左心室质量指数(LVMI)和主动脉弓钙化评分(Ao ACS)。结果经持续性透析3个月后,3组患者的血钙、血红蛋白、白蛋白水平和Ao ACS水平较治疗前明显升高,血磷、PTH、血肌酐、血尿素氮、LVMI水平较治疗前明显下降,差异均有统计学意义(均P <0.05);透析3个月后HDF组和HP组的血钙、血红蛋白、白蛋白水平均明显高于HD组[(2.24±0.19)、(2.25±0.26) mmol/L比(2.08±0.26) mmol/L、(113±19)、(113±18) g/L比(103±19) g/L、(39±5)、(39±5) g/L比(32±4) g/L],血磷、CRP、PTH、血肌酐、血尿素氮、LVMI、Ao ACS水平均明显低于HD组(均P <0.05)。结论 HDF和血液灌流较普通血液透析能更好地清除中大分子毒素,增加透析充分性,改善维持性血液透析患者的营养状况及心血管相关指标。

Objective To explore the effects of hemodialysis,hemodiafiltration(HDF)and hemoperfusion on maintenance hemodialysis(MHD)patients’dialysis adequacy,nutritional status and cardiovascular related indicators.Methods From June 2017 to June 2018,171 MHD patients admitted to the Kidney Disease Center,the First Affiliated Hospital of Xinjiang Medical University were selected.Patients were divided into hemodialysis group(HD group,57 cases),HDF group(57 cases),and hemoperfusion group(HP group,57 cases)according to different therapeutic modes.The HD group received only hemodialysis treatment;the HDF group received hemodialysis+HDF treatment;the HP group received hemodialysis+hemoperfusion treatment.The blood pressure,blood calcium,blood phosphorus,C-reactive protein(CRP),parathyroid hormone(PTH),blood urea nitrogen,serum creatinine,hemoglobin,albumin,left ventricle mass index(LVMI),and aortic arch calcification score(Ao ACS)before and 3 months after dialysis were compared among the three groups.Results After 3 months of continuous dialysis,the blood calcium,hemoglobin,albumin and Ao ACS levels of the three groups were significantly higher than those before treatment,and the blood phosphorus,PTH,serum creatinine,blood urea nitrogen,and LVMI levels were significantly lower than those before treatment(all P<0.05).After 3 months of dialysis,blood calcium,hemoglobin,and albumin levels in the HDF group and HP group were significantly higher than those in the HD group[(2.24±0.19),(2.25±0.26)mmol/L vs(2.08±0.26)mmol/L;(113±19),(113±18)g/L vs(103±19)g/L;(39±5),(39±5)g/L vs(32±4)g/L],and blood phosphorus,CRP,PTH,serum creatinine,blood urea nitrogen,LVMI,and Ao ACS levels in the HDF group and HP group were significantly lower than those in the HD group(all P<0.05).Conclusion HDF and hemoperfusion can remove medium and large toxin molecules better than ordinary hemodialysis,increase dialysisadequacy,and improve the nutritional status and cardiovascular related indicators of MHD patients.