高通量血液透析对慢性肾衰患者甲状旁腺素和β_2微球蛋白的清除作用

High-flux dialysis eliminating intact parathyroid hormone and β_2-microglobulin in patients with chronic renal disease

目的 :探讨血液透滤器用于慢性肾衰患者普通透析的可行性和效果。 方法 :选择 30例长期维持性血透患者 ,治疗组和对照组各 15例。治疗组采用面积 1.3m2 、超滤系数为 30ml·h-1·mmHg-1的聚砜膜高通量透滤器 ,对照组采用面积 1.3m2 、超滤系数 <10ml·h-1·mmHg-1的普通透析器 ,连续观察 4周 ,分析治疗组和对照组患者的症状改善情况 ,测定首次透析前与透析后、透析 2周及 4周后的免疫反应性甲状旁腺素 (iPTH)、β2 微球蛋白 (β2 M)、血磷和清蛋白 (Alb)等指标。 结果 :高通量透滤器透析组患者皮肤瘙痒、关节疼痛、抽搐、肌肉痉挛等症状明显缓解 ,透前与首次透析后、透析 2周和 4周后的iPTH和 β2 M比较差别显著 ,透析 2周、4周后比首次透析后下降更显著。两组不同阶段的Ca2 + 、补体、血红蛋白含量、Alb、白细胞和血小板计数等比较均无显著差别。 结论 :高通量透滤器可以用于普通透析 ,而且透析效果更好 ,对清除iPTH和 β2 M等较大分子的毒素效果显著 ;提示在一定范围内 ,可以采用高通量透滤器血透替代血滤或透滤治疗。

Objective: To observe the efficacy and the feasibility of hemo filter used as hemo dialyzer in hemodialysis. Methods: Thirty cases of chronic hemodialysis patients were divided into treatment group and control group.Each group had 15 patients and they were followed up for 4 weeks.The high flux polysulphone dialyzer with an area of 1.3 m 2 and an ultrafiltration coefficient of 30 ml·h -1 ·mmHg -1 was used in the treated group,while the low flux common dialyzer with an area of 1.3 m 2 and an ultrafiltration coefficient less than 10 ml·h -1 ·mmHg -1 was used in the control group.The intact parathyroid hormone,phosphate,β 2 microglobulin(β 2 M),white blood cell count(WBC),platelet count(PLT) and albumin(Alb) were determined pre dialysis,post dialysis,2 weeks and 4 weeks after dialysis.Results: The symptoms (skin pitch,arthralgia,muscle spasm and so on) of the patients in treatment group were significantly improved.The levels of iPTH,phosphate,β 2 M were markedly reduced post dialysis,2 weeks and 4 weeks after dialysis comparing to those of pre dialysis,while the Ca 2+ ,complement,hemoglobin,WBC,PLT and Alb had no apparent changes.Conclusion: The high flux filter may be used as dialyzer in the common dialysis,it can eliminate iPTH,phosphate and β 2 M and its efficacy is better than common dialyzer.