不同透析膜对维持性血液透析患者骨矿物质代谢及微炎症状态的影响

目的比较不同透析膜和不同膜面积的透析器对维持性血液透析(maintenance hemodialysis,MHD)患者骨矿物质代谢及微炎症状态的影响。方法选择MHD患者40例,随机分为3组:FX组16例(使用德国Fresenius公司FX60型高通量透析器,膜面积1.3m2)、TS组14例(使用日本Toray公司TS-1.3S型高通量透析器,膜面积1.3m2)、CA组10例(使用美国Baxter公司CA-HP-170型低通量透析器,膜面积1.7m2),全部患者每周透析3次,每次4h。比较入组前和治疗3个月、6个月后血清尿素氮(BUN)、肌酐(Cr)、尿酸(Ua)、白蛋白(ALB)、钙(Ca)、磷(P)、甲状旁腺激素(iPTH)、β2微球蛋白(β2-MG)、超敏C反应蛋白(Hs-CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、丙二醛(MDA)和超氧化物歧化酶(SOD)浓度变化。结果各组患者血清BUN、Cr、Ua、P、iPTH、Hs-CRP和IL-6治疗前后无明显差异(P>0.05);β2-MG在3个月、6个月时与基础值比较各组均明显下降(P<0.05),且在治疗6个月时TS组下降最显著(χ2=10.011,P=0.007);3个月时ALB各组均有上升趋势,但6个月CA组明显下降(P<0.05);TNF-αCA组升高,FX组和TS组下降(P<0.05);CA组MDA明显升高(P<0.05),SOD虽有下降趋势,但无统计学意义(P>0.05);FX组和TS组MDA明显下降(P<0.05),且TS组下降更显著(Z=-3.284,P=0.001),SOD3个月即开始下降(P<0.05),6个月与3个月时比较进一步下降(P<0.05)。结论①高通量透析器尽管膜面积较小,但对小分子毒素清除效果与大面积低通量透析器相当。②高通量透析可抑制氧化应激、改善微炎症状态,维持营养平衡。③对预防透析相关淀粉样变,除选用优质透析器外,提高透析液质量和避免各环节污染十分重要。

Effect of different dialysis membrane on mineral metabolism and micro-inflammatory status of maintenance hemodialysis patients

Objective The aim of this study is to compare the effect of three dialyzers with different dialysis membranes and membrane area on mineral metabolism and micro-inflammation status of maintenance hemodialysis （MHD） patients. Method 40 MHD patients were recruited and randomly assigned to 3 groups： 16 patients in FX group （German Fresenius company FX60 high-flux dialyzer, membrane area of 1.3 m2）, 14 patients in TS group （Japanese TORAY company TS-1.3S high-flux dialyzer, membrane area of 1.3 m2）, 10 patients in CA group （United States Baxter company CA-HP-170 low-flux dialyzer, membrane area of 1.7 m2）. All patients received four-hour dialysis three times per week. Serum level of urea nitrogen （BUN）, creatinine （Cr）, uric acid （Ua）, albumin （ALB）, calcium （Ca）, phosphorus （P）, intact PTH（iPTH）, beta2-micro-globulin concentration （β2-MG）, high-sensitive C-reactive protein （Hs-CRP）, superoxide dismutase （SOD）, interleukin-6 （IL-6）, malondialdehyde （MDA）, tumor necrosis factor-α （TNF-u）, at baseline and the end of 3rd and 6th month were compared. Results There is no significant change in serum levels of BUN, Cr, Ua, P, iPTH, Hs-CRP and IL-6 from baseline to the end of 3rd and 6th month （P〉0.05）. In all groups serum levels of 132-MG decreased significantly at the end of 3rd and 6th month （P〈0.05）, and at the end of 6th month the level of β2-MG decreased the most in TS group （χ2=10.011, P=0.007）. In all groups serum levels of ALB increased at the 3rd month, but in CA group it decreased significantly at the 6th month （P〈 0.05）. Serum level of TNF-α increased in CA group while decreased in FX group and TS group （P〈0.05）. In CA group serum level of MDA increased significantly （P〈0.05）, level of SOD decreased insignificantly. In FX group and TS group serum levels of MDA decreased significantly （P〈0.05）, and it decreased more in TS group （Z=- 3.284, F=-0.001）, serum levels of SOD in FX and TS group decreased significantly at 3th month （P〈0.05）, and they both further decreased significantly from the 3rd to the 6th month （P〈0.05）. Conclusion Small-area high-flux dialysis is comparable with low-flux hemodialysis on the removing of small molecular uremic toxins. High-flux dialysis may improve micro-inflammation state, reduce oxidative stress, and keep the balance of nutritional status of MHD patients. Using superior dialyser and high quality dialysate, avoiding contamination during dialysate can reduce the risk of dialysis-related amyloid （DRA）.