上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

高通量血液透析联合血液灌流治疗终末期肾病的效果研究

窦林斌，张伟明，王咏梅，林星辉，蔡宏，周懿君，朱铭力，严玉澄，倪兆慧，钱家麒   

  1. 上海交通大学 医学院附属仁济医院肾脏科， 上海 200127
  • 出版日期:2015-09-28 发布日期:2015-09-30
  • 通讯作者: 张伟明, 电子信箱: weimingzh1965@163.com。
  • 作者简介:窦林斌（1989—）， 男， 硕士生; 电子信箱: dlb1123@126.com。

Therapeutic effect of high-flux hemodialysis combined with hemoperfusion on patients with end stage renal disease

DOU Lin-bin, ZHANG Wei-ming, WANG Yong-mei, LIN Xing-hui, CAI Hong, ZHOU Yi-jun, ZHU Ming-li, YAN Yu-cheng, NI Zhao-hui, QIAN Jia-qi   

  1. Department of Nephrology, Renji Hospital, Shanghai Jiao Tong University School of Medicine,  Shanghai 200127, China
  • Online:2015-09-28 Published:2015-09-30

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摘要：

目的  探讨高通量血液透析（HFD）联合血液灌流（HP）对维持性血液透析（MHD）患者血清成纤维生长因子23（FGF23）、白介素6（IL-6）等中大分子溶质清除以及生活质量改善的影响。方法  入选35例MHD患者，每周行3次透析，其中HFD 2次/周，HFD+HP 1次/周，共治疗12个月。每3个月测定血常规、血清白蛋白、血钙、血磷、全段甲状旁腺激素（iPTH）等指标。第0、6、12个月ELISA法测定血清FGF23和IL-6。研究开始和结束时分别使用SF-36量表评价患者生活质量。结果  完成12个月随访的患者共33例，平均年龄为（59.06±0.64）岁，平均透析龄（178.94±51.50）个月。与治疗前比较，随访期间患者血红蛋白、血清前白蛋白、血清白蛋白、血钙、血磷、iPTH无显著变化。与治疗前比较，患者FGF23在治疗6个月后显著下降（P=0.046），在治疗12个月后进一步下降（P=0.006）。与治疗前比较，患者IL-6在治疗6个月时显著下降（P=0.015），在治疗12个月时进一步下降（P=0.015）。随访12个月后，MHD患者各项评分均有显著改善（P<0.05）。结论  HFD联合HP治疗可有效清除MHD患者中大分子毒素，是改善MHD患者生活质量的有效治疗方法。

关键词: 血液透析, 血液灌流, 成纤维生长因子23, 白介素6, 生活质量

Abstract:

Objective  To investigate the effects of combination of high-flux hemodialysis (HFD) with hemoperfusion (HP) on the removal of middle and large molecule solutes such as serum fibroblast growth factor 23 (FGF23) and interleukin 6 (IL-6) and the improvement of life quality of patients undergoing maintenance hemodialysis (MHD). Methods  A total of 35 MHD patients were enrolled and underwent two HFD and one HFD+HP per week for 12 months. Indexes such as serum albumin, hemoglobin, phosphorus, calcium, and intact parathyroid hormone (iPTH) were measured every 3 months. Serum FGF23 and IL-6 were detected by ELISA in 0, 6, and 12 months. SF-36 scale was used to evaluate the life quality of patients at the beginning and end of study. Results  A total of 33 patients were followed up for 12 months. The mean age was (59.06±0.64) years and mean dialysis vintage was (178.94±51.50) months. Hemoglobin, pre-albumin, albumin, calcium, phosphorus, and iPTH of patients during follow-up were not significantly different from those before treatment. FGF23 decreased remarkably after being treated for 6 months (P=0.046) and decreased continuously after being treated for 12 months (P=0.006). IL-6 decreased remarkably after being treated for 6 months (P=0.015) and decreased continuously after being treated for 12 months (P=0.015). Scores of all items of MHD patients improved significantly after being followed up for 12 months (P<0.05). Conclusion  HFD+HP can efficiently remove middle and large molecule toxins and is an effect treatment for improving the life quality of MHD patients.

Key words: hemodialysis, hemoperfusion, fibroblast growth factor 23, interleukin 6, quality of life