高通量血液透析与腹膜透析对中大分子毒素清除能力的比较

目的 观察腹膜透析、高通量血液透析清除终末期肾功能衰竭患者血液中、大分子溶质的疗效.方法 维持性血液净化患者24例(观察组),采用德国Fresenius 4008S容量控制型透析机和超纯碳酸氢盐透析液行高通量透析,每周3次,每周透析时间>12 h,共观察1年;选择终末期肾功能衰竭行持续性非卧床腹膜透析患者23例(对照组),行Fenekhoff卷曲管及手术置管法,采用Baxter公司生产的双联双袋透析装置及透析液每日交换6～8 L,每次2 L,根据腹膜平衡试验结果和机体日总出入量做相应调整.检测血液β2微球蛋白及甲状旁腺素水平;观察两组患者治疗1年前、后2种溶质含量的变化.结果 通过1年规律治疗,2种透析方式均可显著降低血β2微球蛋白和甲状旁腺素水平(P<0.05),腹膜透析对于β2微球蛋白的清除优于高通量血液透析(P<0.01),而对于甲状旁腺素的清除两者效果相当(P>0.05).结论 高通量血液透析对于中、大分子毒素清除能力接近腹膜透析.在我国国情下,两者均适合终末期肾功能衰竭患者长期维持性肾脏替代治疗的手段.

Highly flux dialysis and peritoneal dialysis in removing macro-middle molecule solutes

Objective To compare the clearance of middle and large molecular substance in patients with highly flux dialysis (HFD) versus Peritoneal Dialysis(PD) .Methods 24 patients receiving end-stage renal disease (ESRD) were chosen. These cases received high flux dialysis (observed group) with three times-weekly session of more than 4 hours following up one year. All patients were dialyzed with Fresenius 4008S. And 23 patients receiving continuous ambulatory peritoneal dialysis( control group) were chosen at the same time, and received 6-8 L per day. Blood β2-microglobulin and parathyroid hormone(PTH) were tested before and after one year's dialysis. Results Compared to pretreatment , the decrease of PTH and β2-mi croglobulin of two groups was significant (P < 0.05). After one year , there was no significant difference be tween observed group and control group in the decrease of PTH( P > 0.05). But the decreases of B2-mi croglobulin of control group were superior to that of observed group( P < 0.01). Conclusion Compared to peritoneal dialysis, highly flux dialysis, which has the nearly clearance of macro-middle molecule toxins, can become as the same important methods in maintenance dialysis.