高流量血液透析对尿毒症维持性血液透析患者血清溶质的清除效果
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摘要
目的探讨高流量血液透析对尿毒症维持性血液透析患者血清溶质的清除效果。方法选取2017年2月至2017年12月于宿州市立医院就诊的尿毒症维持性血液透析患者88例为研究对象,采用随机数表法将其分为观察组(44例)和对照组(44例),观察组患者采用高流量血液透析,对照组患者采用低流量血液透析,对比两组患者血清肌酐(serum creatinine,Scr)、血尿素氮(blood urea nitrogen,BUN)、β_2微球蛋白(β_2-microglobulin,β2M)、丙二醛(malonaldehyde,MDA)及全段甲状旁腺激素(intact parathyroid hormone,iPTH)、血清钙和磷水平。结果透析5次时,两组患者BUN、Scr、β_2M、MDA水平均显著低于本组透析前(P_均<0.05);观察组患者透析5次时Scr、β_2M、MDA水平均显著低于同期对照组(P_均<0.05)。透析12周,两组患者iPTH、血清磷水平均显著低于本组透析前(P_均<0.05),血清钙水平均显著高于本组透析前(P_均<0.05);观察组患者透析12周时iPTH、血清磷水平均显著低于同期对照组(P_均<0.05),血清钙水平显著高于同期对照组(P <0.05)。结论高流量血液透析能够降低尿毒症维持性血液透析患者iPTH、BUN、Scr、β_2M、MDA、血清磷水平,升高血清钙水平。
Objective To investigate the clearance effect of high flow hemodialysis on serum solute in uremia patients with maintenance hemodialysis. Method 88 uremic patients with maintenance hemodialysis from February 2017 to December 2017 were randomly divided into observation group(n = 44) and control group(n = 44). Observation group patients were treated with high flow hemodialysis and control group patients were treated with low flow hemodialysis. The levels of blood urea nitrogen(BUN), serum creatinine(Scr), β_2-microglobulin(β_2M), malonaldehyde(MDA) and intact parathyroid hormone(iPTH), serum calcium and phosphorus of the two groups were compared. Result At 5 dialysis sessions, the levels of BUN, Scr, β_2M and MDA in both groups were significantly lower than those before dialysis(P_(all)<0.05); the levels of Scr, β_2M and MDA in observation group were significantly lower than those in control group(P_(all)< 0.05). After 12 weeks of dialysis, the levels of iPTH and serum phosphorus in both groups were significantly lower than those before dialysis(P_(all)< 0.05), and serum calcium levels were significantly higher than those before dialysis(P_(all)< 0.05). The levels of serum phosphorus and iPTH in observation group were significantly lower than those in control group after 12 weeks of hemodialysis(P_(all)< 0.05), and the level of serum calcium in observation group was significantly higher than that in control group after 12 weeks of hemodialysis(P < 0.05). Conclusion High flow hemodialysis can reduce the levels of BUN, Scr, iPTH, β_2M, MDA and phosphorus in uremic patients with maintenance hemodialysis, and increase the level of serum calcium.
Objective To investigate the clearance effect of high flow hemodialysis on serum solute in uremia patients with maintenance hemodialysis. Method 88 uremic patients with maintenance hemodialysis from February 2017 to December 2017 were randomly divided into observation group(n = 44) and control group(n = 44). Observation group patients were treated with high flow hemodialysis and control group patients were treated with low flow hemodialysis. The levels of blood urea nitrogen(BUN), serum creatinine(Scr), β_2-microglobulin(β_2M), malonaldehyde(MDA) and intact parathyroid hormone(iPTH), serum calcium and phosphorus of the two groups were compared. Result At 5 dialysis sessions, the levels of BUN, Scr, β_2M and MDA in both groups were significantly lower than those before dialysis(P_(all)<0.05); the levels of Scr, β_2M and MDA in observation group were significantly lower than those in control group(P_(all)< 0.05). After 12 weeks of dialysis, the levels of iPTH and serum phosphorus in both groups were significantly lower than those before dialysis(P_(all)< 0.05), and serum calcium levels were significantly higher than those before dialysis(P_(all)< 0.05). The levels of serum phosphorus and iPTH in observation group were significantly lower than those in control group after 12 weeks of hemodialysis(P_(all)< 0.05), and the level of serum calcium in observation group was significantly higher than that in control group after 12 weeks of hemodialysis(P < 0.05). Conclusion High flow hemodialysis can reduce the levels of BUN, Scr, iPTH, β_2M, MDA and phosphorus in uremic patients with maintenance hemodialysis, and increase the level of serum calcium.
引文
[1]中国医师协会肾脏病医师分会血液透析充分性协作组.中国血液透析充分性临床实践指南[J].中华医学杂志,2015,95(34):2748-2753.
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[14]Ulusoy S,Ozkan G,Guvercin B,et al.The Relation Between Variability of Intact Parathyroid Hormone,Calcium,and Cardiac Mortality in Hemodialysis Patients[J].Artificial Organs,2016,40(11):1078-1085.
[15]张跃男,白云娟,王晓媛.不同血液净化方式对维持性血液透析患者残余肾功能的影响[J].中国医药导报,2015,12(12):156-159.
[16]李元宁,张镇.维持性血液透析患者微炎症状态的临床研究[J].中国地方病防治杂志,2016,31(7):806.
[17]罗静,胡红,李莹,等.杂合式血液净化对维持性血液透析患者β2微球蛋白水平及微炎症状态的影响[J].重庆医学,2017,46(29):4070-4071.
[18]邹宝林,黄燕林,郭阳化.维持性血液透析高磷血症患者低磷饮食行为改变阶段健康信念调查[J].广东医学,2017,38(14):2206-2208.
[19]陈波,黄海樱,周强,等.肾功能损伤早期实验室指标的诊断价值比较[J].实用医学杂志,2016,32(1):124-126.
[20]王亿平,陈芳,王东,等.清肾颗粒对慢性肾衰竭湿热证患者氧化应激的干预作用[J].中成药,2017,39(1):46-50.
[2]李雪,孙晓晶.维持性血液透析患者自我感受负担及相关因素[J].中国心理卫生杂志,2016,30(4):258-263.
[3]Jia P,Jin W,Teng J,et al.Acute Effects of Hemodiafiltration Versus Conventional Hemodialysis on Endothelial Function and Inflammation:A Randomized Crossover Study[J].Medicine(Baltimore),2016,95(16):e3440.
[4]杨静,蒋文勇,于黔,等.高通量血液透析对糖尿病肾病维持性血液透析患者氧化应激和微炎症状态的影响[J].广东医学,2016,37(18):2784-2786.
[5]李玉金.低流量和高流量持续血液透析滤过治疗急性肾损伤的效果观察[J].临床心身疾病杂志,2016,22(s2):27-28.
[6]梁丹华,谭荣韶,刘岩,等.三种营养筛查工具对维持性血液透析病人透析相关性蛋白质-能量消耗的评价比较[J].肠外与肠内营养,2017,24(3):138-142.
[7]何立群,许筠,孙伟,等.慢性肾衰竭诊疗指南[J].中国中医药现代远程教育,2011,9(9):132-133.
[8]中国中西医结合学会肾脏疾病专业委员会.慢性肾衰竭中西医结合诊疗指南[J].中国中西医结合杂志,2015,38(9):313-317.
[9]谷卉,杜晓刚.维持性血液透析尿毒症患者的预后及其危险因素研究进展[J].中国全科医学,2018,21(18):2252-2257.
[10]陈曦,臧丛生,于大川.高通量血液透析对尿毒症患者β2微球蛋白清除效果的临床疗效[J].中国老年学杂志,2015,35(8):2237-2238.
[11]钟广芝,胡鹏飞.高通量血液透析对老年慢性肾衰竭患者血清中分子毒素清除效果研究[J].临床和实验医学杂志,2016,15(10):1007-1010.
[12]Brunaud L,Sime WN,Filipozzi P,et al.Minimal impact of calci mimetics on the management of hyperparathyroidism in chronic dialysis[J].Surgery,2016,159(1):183.
[13]王金宝,张金玉,周健美,等.维持性血液透析患者钙、磷、iPTH代谢异常的调查分析[J].实用医学杂志,2016,32(2):333-334.
[14]Ulusoy S,Ozkan G,Guvercin B,et al.The Relation Between Variability of Intact Parathyroid Hormone,Calcium,and Cardiac Mortality in Hemodialysis Patients[J].Artificial Organs,2016,40(11):1078-1085.
[15]张跃男,白云娟,王晓媛.不同血液净化方式对维持性血液透析患者残余肾功能的影响[J].中国医药导报,2015,12(12):156-159.
[16]李元宁,张镇.维持性血液透析患者微炎症状态的临床研究[J].中国地方病防治杂志,2016,31(7):806.
[17]罗静,胡红,李莹,等.杂合式血液净化对维持性血液透析患者β2微球蛋白水平及微炎症状态的影响[J].重庆医学,2017,46(29):4070-4071.
[18]邹宝林,黄燕林,郭阳化.维持性血液透析高磷血症患者低磷饮食行为改变阶段健康信念调查[J].广东医学,2017,38(14):2206-2208.
[19]陈波,黄海樱,周强,等.肾功能损伤早期实验室指标的诊断价值比较[J].实用医学杂志,2016,32(1):124-126.
[20]王亿平,陈芳,王东,等.清肾颗粒对慢性肾衰竭湿热证患者氧化应激的干预作用[J].中成药,2017,39(1):46-50.