高通量血液透析在终末期肾脏病患者中的应用价值

【目的】探讨高通量血液透析（HFHD）在终末期肾脏病（ ESRD）患者中的应用价值。【方法】收集血液透析时间在1年以上的136例ES RD患者的临床资料，根据透析器超滤系数的不同分为三组：超滤系数11．3 mL/（h · mmHg）的低通量8LR组（A组）；超滤系数50 mL/（h ＆#183; mmHg）的高通量PS15组（B组）；超滤系数71 mL/（h ·mmHg）的高通量17R组（C组）。比较三组血液透析前后的血尿素氮（BUN）、肌酐（SCr）、血磷（P3＋）、血钾（K＋）、血清甲状旁腺激素（iPTH）、β2-微球蛋白（β2-MG）、血清白蛋白（ALB）、瘦素（LP）、同型半胱氨酸（Hcy）、维生素B12（Vit B12）等指标，并分析比较各组血液透析后关节病变、腕管综合征、心血管系统等并发症。【结果】三组血BUN、SCr、P3＋、K＋等小分子物质比较无显著性差异（P＞0．05）；而B、C组iPTH、β2-MG、ALB、LP、Hcy、Vit B12等中大分子物质的清除则优于A组（P＜0．05），且C组对中大分子毒素的清除率最高（P＜0．05）；B、C组关节病变、腕管综合征、心血管系统并发症明显少于A组（P＜0．05），而低血压病的发生率高于A组（P ＜0．05），但三组感染率、病死率比较无统计学差异（P ＞0．05）。【结论】HF-HD与低通量血液透析（LFHD）对小分子物质的清除效果相似，但对中大分子物质的清除明显优于LFHD ，且可以减少关节病变、腕管综合征、心血管系统并发症发生，但应注意低血压等不良反应的发生。

Application Value of High-flux Hemodialysis in Patients with End-stage Renal Disease

Objective]To explore the application value of high-flux hemodialysis（HFHD） in patients with end-stage renal disease（ESRD） .Methods]Clinical data of 136 ESRD patients undergoing hemodialysis for more than 1 year were collected .According to ultrafiltration coefficient of dialyzer ,all patients were divided into low-fluxultrafiltration coefficient was 11 .3 mL/（h ＆#183; mmHg）] 8LR group（group A） ,high-fluxultrafil-tration coefficient was 50 mL/（h · mmHg）] PS15 group（group B） and high-fluxultrafiltration coefficient was 71 mL/（h · mmHg）] 17R group（group C） .Blood urea nitrogen（BUN） ,creatinine ,serum phosphorus and potassium clearance ,serum intact parathyroid hormone（iPTH）,β2-microglobulin（β2-MG）,serum albumin （ALB） ,leptin ,homocysteine ,vitamin B12 and other indicators were compared among 3 groups .The incidence of complications such as joint disease ,carpal tunnel syndrome and cardiovascular diseases in 3 groups after dialysis were analyzed and compared .Results] There was no significant difference in blood BUN ,serum creatinine ,serum phosphorus ,serum potassium and other small molecular substances among 3 groups（ P〉0 .05） . The clearance rates of iPTH ,β2-MG ,ALB ,leptin ,homocysteine ,vitamin B12 and other middle or giant molecular substances in group B and group C were better than group A （ P〉0 .05） .The clearance rate of middle or giant molecular toxin in group C was the highest（ P 〉0 .05） .The incidence of complications such as joint disease ,carpal tunnel syndrome and cardiovascular disease in group B and C was lower than that in group A （ P〈0 .05） ,but the incidence of hypotension in group B and C was higher than that in group A （ P 〈0 .05） . There was no significant difference in infection rate and mortality among 3 groups（ P 〉0 .05） .Conclusion]The clearance effect of HFHD on small molecular substances is similar to low-flux hemodialysis（LFHD） ,but its effect on middle or giant molecular substances is