高通量透析改善尿毒症血透患者心功能的临床研究

目的：观察高通量透析（HFHD）对尿毒症血透患者心功能的影响.方法：64例患者随机分为高通量透析组（A组）与低通量透析组（LFHD,B组）,每组各32例,入选时两组患者在临床指标和心功能指标方面差异无统计学意义.于初始治疗前、治疗12个月后分别测定患者心脏结构和功能指标：左心室舒张末期容积（LVDd）、室间隔厚度（IVST）、左心室后壁厚度（LVPWT）、快速充盈期和心房收缩期二尖瓣血流速度比值（E/A）、左室射血分数（EF）和左心室心肌重量指数（LVMI）及抽血检查生化指标：血红蛋白（Hb）、肌酐（Scr）、超敏C反应蛋白（CRP）、甲状旁腺激素（iPTH）、β2微球蛋白（β2MG）、血磷（P3＋）、B型利钠肽（BNP）、血浆白蛋白（Alb）等.结果：透析1年后,HFHD组对PTH、P3＋清除明显高于LFHD组（P〈0.05）,BNP水平明显低于LFHD组（P＜0.05）.HFHD组心功能较LFHD组有明显改善（P〈0.05）.结论：HFHD能更好的改善透析患者的心功能状态,可能与HFHD能清除一些不易被LFHD清除的中大分子毒素、明显改善贫血、微炎症等有关.BNP水平可作为慢性肾衰竭并发心血管疾病患者危险的重要指标之一.

Effect of High Flux Hemodialysis on Cardiovascular Complication of Maintenance Dialysis Patients

ABSTRACT Objective：To investigate the influence of high - flux hemodialysis （HFHD） on cardiovascular complication of maintenance hemodialysis （MHD） patients. Methods ： A total of 64 MHD patients were randomly divided into two groups ： HFHD group and low-flux hemodialysis（LFHD） group. There were 32 cases in each group and no significant difference on parameters of clinic and cardiac structure and function parameters at the time of recruitment, Before and after the treatment, the clinical symptoms were observed, Hb, Cr, CRP, iPTH, BNP, Alb and other biochemical indices were measured at the same time, LVDd, IVST, LVPWT, E/A, EF, LVMI. Results：The clearance of P3＋ ,PTH were significantly higher in HFHD group than LFHD group. BNP lever were significantly lower in HFHD group than LFHD group. Conclusion ： HFHD can improve left ventricular diastolic and systolic function in MHD patients. Possible mechanism may be correlated with the clearance of middle molecular substances, and improving of renal anemia. The BNP level can be an important index of MHD patients with cardiovascular complication.