上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2019, Vol. 39 ›› Issue (8): 886-.doi: 10.3969/j.issn.1674-8115.2019.08.013

• 论著·临床研究 • 上一篇    下一篇

血液透析联合血液灌流治疗维持性血透患者的效果观察

龙泉 1，秦纪平 2，李蓉 2，常娟 2，蒋更如 3，朱淳 2, 3   

  1. 1.上海国际医学中心肾脏内科，上海 201318；2.上海交通大学医学院附属新华医院崇明分院肾脏内科，上海 202150；3.上海交通大学医学院附属新华医院肾脏内科，上海 200092
  • 出版日期:2019-08-28 发布日期:2019-09-23
  • 通讯作者: 朱淳，电子邮箱：zhuchun26@sina.cn。
  • 作者简介:龙泉（1981—），女，主治医师，博士；电子信箱： louisa0920@163.com。
  • 基金资助:
    上海市卫生和计划生育委员会科研课题（201540095）

Effects of hemodialysis and hemoperfusion combination treatment on maintenance hemodialysis patients

LONG Quan1, QIN Ji-ping2, LI Rong2, CHANG Juan2, JIANG Geng-ru3, ZHU Chun2, 3   

  1. 1. Department of Nephrology, Shanghai International Medical Center, Shanghai 201318, China; 2. Department of Nephrology, Chongming Branch of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 202150, China; 3. Department of Nephrology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
  • Online:2019-08-28 Published:2019-09-23
  • Supported by:
    Scientific Research Foundation of Shanghai Municipal Commission of Health and Family Planning, 201540095

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摘要： 目的 ·观察血液透析（ hemodialysis，HD）联合血液灌流（ hemoperfusion，HP）对维持性血透（ maintenance hemodialysis， MHD）患者的治疗效果，探讨组合型血液净化治疗在 MHD患者中的有效性和安全性。方法 · 2017年 7月—2018年 7月，选取在上海交通大学医学院附属新华医院崇明分院血透中心进行 MHD的 80例患者，采用随机数字表法将患者分为 2组，即 HD+HP组（n40）和 HD组（n40）。每 3个月随访一次，共随访 1年。比较 2组患者的实验室指标、透析充分性指标和肾脏疾病生活质量简表（Kidney Disease Quality of Life-Short Form，KDQOL-SF）评分的变化情况，并记录患者的转归、死因和不良事件。结果 · 1年治疗结束时， HD+HP组患者的甲状旁腺激素（ parathyroid hormone，PTH）、β2微球蛋白（ β2-microglobulin，β2-MG）、高敏 C反应蛋白（high sensitive C-reactive protein，hsCRP）、白细胞介素 -6（interleukin-6，IL-6）、肿瘤坏死因子 α（tumor necrosis factor-α，TNF-α）以及左心室质量指数（ left ventricular mass index，LVMI）水平均显著低于 HD组（均 P<0.05），而血红蛋白水平和 KDQOL-SF评分均显著高于 HD组（均 P<0.05）。2组患者的铁代谢指标、血钙、血磷、血清白蛋白和尿素清除指数（ Kt/V）的差异均无统计学意义（均 P>0.05）。HD+HP组和单纯 HD组患者的全因死亡率分别为 12.5%和 32.5%。2组均未发现严重的不良事件。结论 · HD联合 HP治疗在清除 MHD患者体内中大分子毒素、减轻体内微炎症状态、改善贫血和左心室肥厚方面的效果明显优于单纯 HD治疗，同时在提高患者生活质量方面可能具有潜在优势。

关键词: 血液透析, 血液灌流, 甲状旁腺激素, &, beta, 2微球蛋白, 微炎症, 贫血, 生活质量

Abstract:

Objective · To investigate the effects of hemodialysis (HD) and hemoperfusion (HP) combination treatment on maintenance hemodialysis (MHD) patients. Methods · A total of 80 MHD patients in Chongming Branch of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine July 2017 to July 2018 were randomly divided into two groups, i.e., HD+HP group (n40) and HD group (n40). The patients were followed up every 3 months for 1 year. The changes of laboratory indexes, dialysis adequacy indicators and quality of life scores of Kidney Disease Quality of Life-Short Form (KDQOL-SF) were compared between the two groups, and the prognosis, causes of death and adverse events were recorded. Results · At the endofone-year treatment,levels ofparathyroidhormone (PTH), β2-microglobulin(β2-MG),high sensitiveC-reactiveprotein (hsCRP),interleukin-6(IL-6), tumor necrosis factor-α (TNF-α) andleftventricular mass index (LVMI)weresignificantly lower in HD+HPgroupthanthose inHD group(P<0.05), while the level of hemoglobin and the KDQOL-SF score were significantly higher in HD+HPgroup than those in HD group (P<0.05). There were no significant differences in the indexes of iron metabolism, calcium, phosphorus, albumin and urea clearance index (Kt/V) between the two groups (P>0.05). The overall mortality rates of HD+HP group and HD group were 12.5% and 32.5%, respectively. No significant adverse events were observed during the follow-up. Conclusion · The effects ofHDcombinedwith HPonclearingmiddle andlarge moleculartoxins,reducing microinflammation status,and improvingrenal anemia and left ventricular hypertrophy are better than those of only HD. There may be potential advantages of HD and HP combination in improving quality of life in MHD patients as well.

Key words: hemodialysis(HD), hemoperfusion(HP), parathyroidhormone(PTH), &beta;2-microglobulin(&beta;2-MG), microinflammation, anemia, qualityoflife

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