高通量透析与常规血液透析联合血液透析滤过对β_2微球蛋白、甲状旁腺激素清除效果比较
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摘要
目的:比较高通量血液透析与常规血液透析联合血液透析滤过对维持性血液透析患者β_2微球蛋白、甲状旁腺激素清除效果。方法:回顾性分析在笔者所在医院维持性血液透析的54例患者临床资料,按血液净化方式不同分为高通量透析(HFHD)组28例、常规血液透析联合血液透析滤(HD+HDF)组26例,HFHD组每周透析3次,4 h/次;HD+HDF组每周HD 2次+HDF 1次,4 h/次。观察治疗前、治疗后1个月及治疗后3个月尿素氮(BUN)、血清肌酐(Scr)、血钙(Ca~(2+))、血磷(P~(3-))、甲状旁腺激素(PTH)、β_2微球蛋白(β_2-MG)、血红蛋白(Hb)、白蛋白(Alb)变化。结果:治疗后1个月两组患者β_2-MG、PTH较治疗前有所下降,但差异无统计学意义(P>0.05);治疗3个月后两组β_2-MG、PTH较治疗前明显下降,差异有统计学意义(P<0.05),两组间β_2-MG、PTH比较,差异无统计学意义(P>0.05)。结论:高通量透析、常规血液透析联合血液透析滤对中分子毒素β_2-MG、PTH清除效果大致相当。高通量透析具有操作简便和成本效益比相对低的优势,值得临床推广。
Objective:To compare the efficacies of removing β_2-Microglobulin and parathyroid hormone with high flux hemodialysis to conventional hemodialysis combination of hemodiafiltration.Method:The 54 patients with maintenance hemodialysis were divided into two groups:HFHD group 28 cases,and HD+HDF group 26 cases.HFHD group on 4 hours treatment with 3 times per week,HD+HDF group on 4 hours treatment with HD2 times per week plus HDF1 time per week.The levels of BUN,Scr,Ca~(2+),P~(3-),PTH,β_2-MG,Hb,Alb were compared between these two groups after one month and three month treatment to that before the treatment.Result:After one month treatment,the levels of β_2-microglobulin and parathyroid hormone were decreased in both HFHD group and HD+HDF group with no significantly compared to that before the treatment(P>0.05);After tree month treatment,the levels of β_2-microglobulin and parathyroid hormone were decreased in both HFHD group and HD+HDF group with significantly compared to that before the treatment(P<0.05).Compared the levels of β_2-microglobulin and parathyroid hormone in HFHD group to that in HD+HDF group with no significantly after three month treatment(P>0.05).Conclusion:The efficacies on removing β_2-microglobulin and parathyroid hormone with high flux hemodialysis and conventional hemodialysis combination of hemodiafiltration with no significantly different.High flux hemodialysis has the advantages of simple operation and relatively low cost-effectiveness ratio,and is worthy of clinical promotion.
Objective:To compare the efficacies of removing β_2-Microglobulin and parathyroid hormone with high flux hemodialysis to conventional hemodialysis combination of hemodiafiltration.Method:The 54 patients with maintenance hemodialysis were divided into two groups:HFHD group 28 cases,and HD+HDF group 26 cases.HFHD group on 4 hours treatment with 3 times per week,HD+HDF group on 4 hours treatment with HD2 times per week plus HDF1 time per week.The levels of BUN,Scr,Ca~(2+),P~(3-),PTH,β_2-MG,Hb,Alb were compared between these two groups after one month and three month treatment to that before the treatment.Result:After one month treatment,the levels of β_2-microglobulin and parathyroid hormone were decreased in both HFHD group and HD+HDF group with no significantly compared to that before the treatment(P>0.05);After tree month treatment,the levels of β_2-microglobulin and parathyroid hormone were decreased in both HFHD group and HD+HDF group with significantly compared to that before the treatment(P<0.05).Compared the levels of β_2-microglobulin and parathyroid hormone in HFHD group to that in HD+HDF group with no significantly after three month treatment(P>0.05).Conclusion:The efficacies on removing β_2-microglobulin and parathyroid hormone with high flux hemodialysis and conventional hemodialysis combination of hemodiafiltration with no significantly different.High flux hemodialysis has the advantages of simple operation and relatively low cost-effectiveness ratio,and is worthy of clinical promotion.
引文
[1]Argtropoulos C P,Chen S S,Ng Y H,et al.Rediscovering Beta-2Microglobulin As a Biomarker across the Spectrum of Kidney Diseases[J].Front Med(Lausanne),2017,4:73.
[2]Saliba W,El-haddad B.Secondary hyperparathyroidism:pathophysiology and treatment[J].J Am Board Fam Med,2009,22(5):574-581.
[3]Cheung A K,Rocco M V,Yan G,et al.Serum beta-2 microglobulin levels predict mortality in dialysis patients:results of the HEMO study[J].J Am Soc Nephrol,2006,17(2):546-555.
[4]葛均波,徐永健.内科学[M].第8版.北京:人民卫生出版社,2013:524.
[5]杜梨果,徐小,胡玉刚,等.高通量和低通量透析对维持性血液透析患者生存率影响的Meta分析[J].临床肾脏病杂志,2016,16(10):607-612.
[6]Topciu-Shufta V,Miftari R,Haxhiberiri V,et al.Association of Beta-2Microglobulin with Inflammation and Dislipidemia in High-Flux Membrane Hemodialysis Patients[J].Med Arch,2016,70(5):348-350.
[7]夏文宏,周慧霞.高通量血液透析、血液透析滤过和常规血液透析效果比较[J].新乡医学院学报,2015,32(5):422-425.
[8]戴兵,梅长林.血液透析充分性的评价[J].现代实用医学,2016,28(4):422-425.
[9]王质刚.血液净化学[M].第4版.北京:北京科学技术出版社,2016:842-850.
[10]涂晓文,刘晓莉,许倬,等.高通量血液透析对尿毒症患者甲状旁腺激素和微炎症状态的影响[J].中华危重病急救医学,2014,26(4):275-276.
[11]Leypoldt J K.Solute fluxes in different treatment modalities[J].Nephrol Dial Transplant,2000,15(Suppl 1):3-9.
[12]宋韩明,蔡砺,吕继成,等.血液透析滤过和高通量透析对β2-微球蛋白清除效果的比较[J].中国血液净化,2010(1):19-24.
[13]黄军悦,马志刚,薛嵘,等.不同血液净化方式对维持性血液透析患者β2-微球蛋白及钙磷代谢的影响[J].临床荟萃,2017(7):575-578.
[14]Goto S,Fikagawa M.Clinical aspect of recent progress in phosphate metabolism.Pathophysiology of secondary hyperparathyroidism in chronic kidney disease[J].Clin Calcium,2009,19(6):809-814.
[15]戎殳,叶朝阳,马熠熠,等.高通量血液透析与常规血液透析联合血液透析滤过的临床疗效比较[J].临床肾脏病杂志,2013,13(2):55-59.
[16]马晓莉,孙雪峰,李敏侠,等.高通量血液透析对肾性贫血的影响[J].中国中西医结合肾病杂志,2013,14(2):114-116.
[17]张志坚,陈涵枝,孙铸兴,等.高通量透析对终末期肾衰患者FGF-23及微炎症状态的影响[J].中华医学杂志,2015,95(26):2074-2078.
[2]Saliba W,El-haddad B.Secondary hyperparathyroidism:pathophysiology and treatment[J].J Am Board Fam Med,2009,22(5):574-581.
[3]Cheung A K,Rocco M V,Yan G,et al.Serum beta-2 microglobulin levels predict mortality in dialysis patients:results of the HEMO study[J].J Am Soc Nephrol,2006,17(2):546-555.
[4]葛均波,徐永健.内科学[M].第8版.北京:人民卫生出版社,2013:524.
[5]杜梨果,徐小,胡玉刚,等.高通量和低通量透析对维持性血液透析患者生存率影响的Meta分析[J].临床肾脏病杂志,2016,16(10):607-612.
[6]Topciu-Shufta V,Miftari R,Haxhiberiri V,et al.Association of Beta-2Microglobulin with Inflammation and Dislipidemia in High-Flux Membrane Hemodialysis Patients[J].Med Arch,2016,70(5):348-350.
[7]夏文宏,周慧霞.高通量血液透析、血液透析滤过和常规血液透析效果比较[J].新乡医学院学报,2015,32(5):422-425.
[8]戴兵,梅长林.血液透析充分性的评价[J].现代实用医学,2016,28(4):422-425.
[9]王质刚.血液净化学[M].第4版.北京:北京科学技术出版社,2016:842-850.
[10]涂晓文,刘晓莉,许倬,等.高通量血液透析对尿毒症患者甲状旁腺激素和微炎症状态的影响[J].中华危重病急救医学,2014,26(4):275-276.
[11]Leypoldt J K.Solute fluxes in different treatment modalities[J].Nephrol Dial Transplant,2000,15(Suppl 1):3-9.
[12]宋韩明,蔡砺,吕继成,等.血液透析滤过和高通量透析对β2-微球蛋白清除效果的比较[J].中国血液净化,2010(1):19-24.
[13]黄军悦,马志刚,薛嵘,等.不同血液净化方式对维持性血液透析患者β2-微球蛋白及钙磷代谢的影响[J].临床荟萃,2017(7):575-578.
[14]Goto S,Fikagawa M.Clinical aspect of recent progress in phosphate metabolism.Pathophysiology of secondary hyperparathyroidism in chronic kidney disease[J].Clin Calcium,2009,19(6):809-814.
[15]戎殳,叶朝阳,马熠熠,等.高通量血液透析与常规血液透析联合血液透析滤过的临床疗效比较[J].临床肾脏病杂志,2013,13(2):55-59.
[16]马晓莉,孙雪峰,李敏侠,等.高通量血液透析对肾性贫血的影响[J].中国中西医结合肾病杂志,2013,14(2):114-116.
[17]张志坚,陈涵枝,孙铸兴,等.高通量透析对终末期肾衰患者FGF-23及微炎症状态的影响[J].中华医学杂志,2015,95(26):2074-2078.