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

目的比较高通量血液透析（HFHD）与常规血液透析（HD）联合血液透析滤过（HDF）治疗尿毒症患者的有效性和安全性。方法选择维持性血液透析（MHD）患者55例，分为治疗组（高通量血液透析，3次／周）29例；对照组（低通量血液透析2次／周＋血液透析滤过1次／周）26例，随访6个月，进入试验前1周内（基线期）及开始治疗后3、6个月测定周中透析前血常规、肝肾功能、电解质、全段甲状旁腺激素（iPTH）、132微球蛋白（132一MG）、C反应蛋白（CRP），记录每次透析透前、透后血压。结果2组血常规、白蛋白、CRP、电解质、VI＇H、血脂等指标各时期的组内及组间均无统计学差异（P〉（）．05）。各时期每次透析前、后收缩压（SE｜P）、舒张压（I）J妒）的组间比较无统计学差异（P〉O．05）。治疗组自开始治疗后第1月起至第6月透析前SBP较基线期显著下降（P〈f）．05）。2组各个时期血清胆一MG及血磷比较无显著差异，但治疗组第6个月的血磷值显著低于基线期（P〈0．01）。结论两种透析方式长期疗效可能是相当的，HFHD组血压的控制及血磷的清除更好，可能更有临床推广的潜力。

Comparison of efficacy and safety of High-flux hemodialysis and conventional hemodialysis combining he-modiafiltration

Objective To compare the efficacy and safety of high flux hemodialysis （HFHD） with conventional hemodialysis （HD） combining hemodiafiltration （HDF） therapy in uremia patients. Methods Fifty-five maintenance hemodialysis （MHD） patients were randomly divided into experimen- tal group （high-flux hemodialysis, 3 times / week） and the control group （low-flux blood dialysis 2 times / week ＋ hemodiafiltration 1 / weeks）, followed up for 6 months. Blood routine, liver and kidney function, electrolytes, intact parathyroid hormone （iPTH）, 132-microglobulin （ 132-MG）, C-reactive pro- tein （CRP） were measured midweek predialysis at the baseline and after 3 and 6 months treatment. All pre- and post- dialysis blood pressure were recorded. Results The blood routine, albumin, CRP, elec- trolytes,PTH and cholesterol of all periods in each group and between groups were not significantly different, pre- and post- dialysis systolic blood pressure （SBP）, diastolic blood pressure （DBP） were no significant difference between the two groups at each period. In the test group predialysis SBP was sig- nificantly lower compared with the baseline period （P〈0. 05） since 1 month after treatment. At each period serum 132 MG and phosphorus was no significant difference between two groups, value, but in test group serum phosphorus of 6 months after treatment was significantly lower than baseline （P〈 0. 01）. Conclusions The long term efficacy of the two dialysis pattern may be considerable, blood pressure control and phosphorus removal may be better in HFHD group.