不同膜材料透析器在单次透析治疗中的临床对比研究

A clinical comparison on high-flux dialyzers with different membranes during a single hemodialysis treatment

目的探究高通量聚砜膜透析器(威高HF15)和三醋酸纤维素膜透析器(尼普洛FB-150U,简称150U)在单次透析治疗中的临床效果,包括透析器的清除有效性及生物相容性对比。方法选取威高血液净化中心维持性血液透析患者20例,分为HF15组和150U组,每组10例。分别在透析治疗前、透析15min、透析60min及透析治疗结束后采集患者血样并进行检测。对比HF15和150U对应的透析前后溶质下降率和清除率,以及血细胞和补体因子(C3a)等指标的差异。结果2组患者的年龄、性别、体质量和透析龄等差异无统计学意义(P>0.05),使用HF15和150U透析治疗前,组间透析血流量、中小分子毒素、血细胞及补体因子等基线数据差异无统计学意义(P>0.05)。4小时常规血液透析治疗后:①2组间小分子毒素尿素氮、肌酐和血磷下降率(t=0.932、1.799、0.878,P=0.376、0.106、0.403)和清除率(t=-1.892、1.500、-2.211,P=0.091、0.168、0.056)无显著性差异;②对中分子毒素的清除效果,HF15组对应的β2微球蛋白下降率(t=7.821,P<0.001)和清除率(t=2.686,P=0.013)均显著高于150U;③在透析治疗过程中,2组患者的血细胞和C3a变化差异无统计学意义(P>0.05)。结论在单次血液透析治疗过程中,HF15对毒素分子的清除效果优于150U,2款透析器生物相容性等同。

Background High-flux hemodialysis has been widely used and has the advantages of improved clearance of uremic toxins and efficient removal of extra body fluid due to the hollow fiber membranes with a high ultrafiltration coefficient.Objective The present paper aims to investigate the clinical performance of two high-flux dialyzers,one equipped with polysulfone membranes(HF15 from Weigo),and the other equipped with cellulose triacetate membranes(FB-150U,short for 150U,from Nipro).Clearance efficiency of uremic toxins and the biocompatibility in a single hemodialysis session were compared between the two types of high-flux dialyzers.Methods A total of 20 patients treated with maintenance hemodialysis for more than 3 months were recruited from Weigao Blood Purification Center and were divided into two groups,HF15 Group(n=10)and 150U Group(n=10).Blood samples were collected right before the dialysis treatment,15min and 60min during the treatment,and right after the treatment.The reduction ratio and clearance rate of uremic toxins as well as changes of blood cells and complement factor(C3a)were compared between the two groups.Results Age,sex,body weight and dialysis age were similar between two groups.Before the dialysis session,baseline parameters including treatment blood flow,small and medium molecule toxins,blood cells and complement factors had no significant differences between the two groups(P≥0.05).After the high-flux hemodialysis treatment for 4 hours,the reduction ratios and clearance rates of small molecule toxins(blood urea nitrogen,creatinine and phosphorus)had no significant differences between the two groups(For reduction ratios:t=0.932,1.799 and 0.878 respectively;P=0.379,0.052 and 0.299 respectively.For clearance rates:t=-1.892,1.500 and-2.211 respectively;P=0.091,0.168 and 0.056 respectively);HF15 group had higher reduction ratio(t=7.821,P<0.001)and clearance rate(t=2.686,P=0.013)of the middle molecular toxinβ2 microglobulin than 150U group.Variations of blood cells and C3a during the hemodialysis session had no statistical significances between two groups.Conclusions During a single high-flux hemodialysis session,HF15 group had higher clearance rates of uremic toxins than 150U group,with equal biocompatibility between the two groups.