摘要
目的探讨不同血液净化方式对维持性血液透析(MHD)患者尿毒素的清除效果。方法 60例MHD患者,随机分为血液透析(HD)组、血液透析滤过(HDF)组、血液灌流(HP)联合血液透析(HP+HD)组,每组20例。收集患者的临床资料,并检测透析前后血清尿素氮(BUN)、血清肌酐(sCr)、全段甲状旁腺激素(iPTH)、硫酸吲哚酚(IS)、硫酸对甲酚(PCS)、同型半胱氨酸(Hcy)和晚期糖基化终末产物(AGEs)水平。结果 HD组、HDF组和HP+HD组透析后BUN、sCr水平均显著低于同组透析前(P值均<0.05),HDF组和HP+HD组透析后iPTH水平均显著低于同组透析前(P值均<0.05),HD组透析前后iPTH水平的差异无统计学意义(P>0.05);HDF组和HP+HD组iPTH下降率均显著高于HD组(P值均<0.05),3组间BUN、sCr下降率的差异均无统计学意义(P值均>0.05)。HD组透析前后IS、PCS、Hcy、AGEs水平的差异均无统计学意义(P值均>0.05),HDF组和HP+HD组透析后IS、PCS、Hcy、AGEs水平均显著低于同组透析前(P值均<0.05);HDF组和HP+HD组IS、PCS、Hcy、AGEs下降率均显著高于HD组(P值均<0.05)。结论 3种血液净化方式均能有效清除小分子毒素,HDF和HP联合HD清除iPTH的效果明显优于HD,HDF与HP联合HD清除蛋白结合毒素的效果相当。
Objective To compare the removal efficiency of uremic toxins by hemodialysis （HD）, hemodiafiltration （HDF） and hemoperfusion （HP） plus hemodialysis （HP ＋ HD） in patients undergoing maintenance hemodialysis （MHD）. Methods Sixty MHD patients were randomly divided into HD group, HDF group and HP＋ HD group. General clinical information was recorded. The indexes including blood urea nitrogen （BUN）, serum creatinine （SCr）, intact parathyroid hormone （iPTH）, indoxyl sulfate （IS）, p-cresyl sulfate （PCS）, homocysteine （Hcy） and advanced glycosylation end products （AGEs） were detected before and after treatment. Results Plasma levels of BUN and sCr after treatment were significantly lower than those before treatment in the three groups （all P〈0. 051. Serum iPTH after treatment was significantly lower than that before treatment in HDF group and HP＋HD group （both P〈0. 05）, but iPTH level was not significantly changed after treatment in HD group （P〉 0. 05）. Serum iPTH reduction rate in HDF group and HP＋ HD group was significantly higher than that in HD group （both P〈0. 05）. There were no significant differences in the reduction rate of BUN or sCr between groups （all P〈0.05）. The levels of IS, PCS, Hcy and AGEs after treatment were significantly lower than those before treatment in HDF group and HP＋ HD group （all P-〈0. 051, but these parameters were not significantly changed after treatment in HD group （all P〈0. 051..Serum reduction rates of IS, PCS, Hcy and AGEs in HDF group and HP ＋ HD group were significantly higher than those in HD group （all P〈0.05）. Conclusion Three ways including HD., HP＋ HD and HDF can effectively remove micromolecule uremic toxins. HDF and HP＋ HD are superior to HD in removal of iPTH. But HDF has the similar removal efficiency with HP ＋ HD for protein-bound uremic toxins
出处
《上海医学》
北大核心
2017年第8期491-494,共4页
Shanghai Medical Journal
基金
上海市卫生和计划生育委员会中医药科技创新项目(ZYKC201601030)
闵行区领军人才后备队培养计划资助
关键词
维持性血液透析
血液净化
尿毒素
Maintenance hemodialysis
Hemopurification
Uremic toxins
