不同血液净化方法对维持性血液透析患者血清β2-微球蛋白和甲状旁腺激素清除率的探讨

目的探讨不同血液净化方法对维持性血液透析(maintenance hemodialysis,MHD)患者中分子物质β2-微球蛋白(β2-microglobulin,β2-MG)及甲状旁腺素(parathyroid hormone,PTH)的清除效果。方法选取2008年5月～2010年9月在广西玉林市第一人民医进行维持性血液透析患者54例并随机分为3组:血液灌流联合血液透析(HD+HP)组(n=18),血液透析滤过(HDF)组(n=18)和血液透析(HD)组(n=18)。比较3组患者治疗12个月前、后血β2-微球蛋白及血PTH清除率。结果 3组治疗后血清β2-微球蛋白和甲状旁腺激素水平均较治疗前下降,HD组治疗后血β2-微球蛋白及甲状旁腺素下降,但无统计学差异(所有P>0.05)。而(HP+HD)组、HDF组相比与透析治疗前血β2-微球蛋白及甲状旁腺素水平均显著下降(P<0.01)。3组之间对β2-微球蛋白及甲状旁腺素清除率比较表明,(HP+HD)组、HDF组β2-微球蛋白及甲状旁腺素下降优于HD组(P<0.01),而(HP+HD)组与HDF组比较差异无统计学意义(P=0.33)。结论血液灌流联合血液透析、血液透析滤过均能有效清除血清β2-微球蛋白和甲状旁腺激素,而血液透析不能有效地清除血清β2-微球蛋白和甲状旁腺激素。

Investigation of various blood purification methods on the clearance of serumβ2-microglobulin and parathyroid hormone in maintenance hemodialysis patients

Objective To investigate the clearance effect of three blood purification methods on serum β2-microglobulin (β2-MG) and parathyroid hormone (PTH) levels in maintenance hemodialysis patients. Methods A total of 54 patients on maintenance hemodialysis treated in our hospital during the period of May 2008 to September 2010 were recruited. They were randomly assigned into 3 groups, hemodialysis (HD) group (n=18), hemodiafihration (HDF) group (n=18), and hemoperfusion + hemodialysis (HD+HP) group (n=18). Blood samples were taken for the assays of serum β2-MG and PTH before and after the treatment. Results Serum β2MG and PTH levels decreased after the treatment in all 3 groups. Serum β2-MG and PTH levels decreased significantly in HP+HD group and HDF group after the treatment (t =12.47, P =0.0034 in HP+HD group; t = 8.57, P =0.0082 in HDF group), but insignificantly in HD group (P>0.05). The clearance effects of β2-MG and PTH were better in HP+HD and HDF groups than in HD group (t =10.19, P =0.0049 for β2-MG clearance; t = 9.43, P =0.0071 for PTH clearance), but without significant differences between HP+HD group and HDF group (t =1.41, P =0.33). Conclusion Serum β2-MG and PTH can be cleared efficiently by HD+HP or HDF, but inefficiently by HD.