高通量血液透析与联机血液透析滤过联合治疗慢性肾衰竭疗效观察

Curative effect of high-flux hemodialysis combined with online hemodiafiltration in the treatment of chronic renal failure

目的比较高通量血液透析(HFHD)与联机血液透析滤过(OL-HDF)联合治疗慢性肾衰竭(CRF)的临床效果。方法选择2018年10月至2019年10月洛阳市东方人民医院收治的90例CRF患者为研究对象,根据血液透析方法将患者分为观察组(n=49)和对照组(n=41)。对照组患者给予HFHD治疗,每周3次;观察组患者给予HFHD和OL-HDF联合治疗,每2周5次HFHD和1次OL-HDF。分别于治疗前及治疗3个月后检测2组患者血清中尿素、尿酸、β_(2)-微球蛋白(β_(2)-MG)和甲状旁腺激素(PTH)水平,并计算尿素清除指数(Kt/V)、标准蛋白分解代谢率(nPCR)和时间平均尿素浓度(TAC_(urea));分别于治疗前及治疗12个月后采用视觉模拟评分法(VAS)评估2组患者的皮肤瘙痒情况,并观察患者治疗12个月内并发症的发生情况。结果治疗前2组患者血清中尿素、尿酸、PTH和β_(2)-MG水平比较差异无统计学意义(P>0.05),2组患者治疗3个月后血清中尿素、尿酸、PTH和β_(2)-MG水平显著低于治疗前(P<0.05);治疗3个月后,2组患者血清中尿素、尿酸水平比较差异无统计学意义(P>0.05),但观察组患者血清中PTH、β_(2)-MG水平显著低于对照组(P<0.05)。治疗3个月后,2组患者的Kt/V、nPCR和TAC_(urea)比较差异无统计学意义(P>0.05)。治疗前2组患者皮肤瘙痒VAS评分比较差异无统计学意义(P>0.05),2组患者治疗12个月后皮肤瘙痒VAS评分显著低于治疗前(P<0.05);治疗12个月后,观察组患者皮肤瘙痒VAS评分显著低于对照组(P<0.05)。治疗前观察组和对照组患者并发症发生率分别为65.31%(32/49)、63.41%(26/41),治疗12个月后观察组和对照组患者并发症发生率分别为10.20%(5/49)、36.59%(15/41)。治疗前2组患者并发症发生率比较差异无统计学意义(χ^(2)=0.035,P>0.05),2组患者治疗12个月后并发症发生率显著低于治疗前(χ^(2)=31.654、5.902,P<0.05);治疗12个月后,观察组患者并发症发生率显著低于对照组(χ^(2)=8.988,P<0.05)。结论与单独HFHD治疗相比,HFHD与OL-HDF联合治疗可以更有效地清除CRF患者血液中的PTH、β_(2)-MG等中、大分子物质,减轻患者皮肤瘙痒症状,降低并发症发生率。

Objective To compare the clinical curative effect of high-flux hemodialysis(HFHD)combined with online hemodiafiltration(OL-HDF)in the treatment of chronic renal failure(CRF).Methods A total of 90 CRF patients admitted to Luoyang Dongfang People′s Hospital from October 2018 to October 2019 were selected as the research subjects,and the patients were divided into the observation group(n=49)and control group(n=41)according to the method of hemodialysis.The patients in the control group were treated with HFHD,three times a week.The patients in the observation group were given the combined treatment of HFHD and OL-HDF,five times of HFHD and one time of OL-HDF every two weeks.The levels of serumurea,uric acid,β_(2)-microglobulin(β_(2)-MG)and parathyroid hormone(PTH)of patients in the two groups were detected before treatment and after three months of treatment,and theureaclearance index(Kt/V),normalized protein catabolic rate(nPCR)and time-average concentration ofurea(TAC_(urea))were calculated.The skin pruritus of patients in the two groups was evaluated by visual analogue scale(VAS)before treatment and after 12 months of treatment.The incidence of complications within 12 months of treatment was observed.Results There was no significant difference in serumurea,uric acid,PTH andβ_(2)-MG levels between the two groups before treatment(P>0.05).The levels of serumurea,uric acid,PTH andβ_(2)-MG of patients in the two groups after three months of treatment were significantly lower than those before treatment(P<0.05).After three months of treatment,there was no significant difference in serumureaand uric acid levels of patients between the two groups(P>0.05),but the serum PTH andβ_(2)-MG levels of patients in the observation group were significantly lower than those in the control group(P<0.05).There was no significant difference in Kt/V,nPCR and TAC_(urea)of patients between the two groups after three months of treatment(P>0.05).There was no significant difference in VAS score of skin pruritus between the two groups before treatment(P>0.05).The VAS score of skin pruritus of patients in the two groups after 12 months of treatment was significantly lower than that before treatment(P<0.05).After 12 months of treatment,the VAS score of skin pruritus of patients in the observation group was significantly lower than that in the control group(P<0.05).Before treatment,the incidence of complications of patients in the observation group and the control group was 65.31%(32/49)and 63.41%(26/41),respectively.After 12 months of treatment,the incidence of complications of patients in the observation group and the control group was 10.20%(5/49)and 36.59%(15/41),respectively.There was no significant difference in the incidence of complications of patients between the two groups before treatment(χ^(2)=0.035,P>0.05).The incidence of complications of patients after 12 months of treatment was significantly lower than that before treatment in the two groups(χ^(2)=31.654,5.902;P<0.05).After 12 months of treatment,the incidence of complications of patients in the observation group was significantly lower than that in the control group(χ^(2)=8.988,P<0.05).Conclusion Compared with HFHD alone,the combined treatment of HFHD and OL-HDF can more effectively remove PTH,β_(2)-MG and other medium and macromolecular substances in blood of CRF patients,relieve the symptoms of skin pruritus,and reduce the incidence of complications.