血液透析、血液透析滤过及连续肾脏替代治疗对尿毒症毒素的清除作用及对动脉粥样硬化程度的影响

目的探讨不同血液净化方式对尿毒症毒素的清除效果及对动脉粥样硬化程度的影响。方法选择2013年1~12月在武汉大学人民医院进行血液净化治疗的尿毒症患者68例,根据透析方法分为单纯透析（HD）组（22例）,血液透析＋血液透析滤过（HD＋HDF）组（28例）,血液透析＋连续肾脏替代治疗（HD＋CRRT）组（18例）。比较3组透析前后同型半胱氨酸（Hcy）、瘦素、晚期糖基化终产物（AGEs）、甲状旁腺激素（iPTH）变化、颈动脉内膜-中层厚度（IMT）及粥样硬化斑块面积。结果单次透析后HD＋HDF组和HD＋CRRT组Hcy[（21.8±5.3）、（21.6±7.2）μmol/L]、瘦素[（10.8±2.2）、（11.9±3.5）μg/L]、AGEs[（25.8±4.1）、（20.2±2.6）μg/L]、iPTH[（1.7±0.6）、（1.7±0.5）μg/L]均显著下降,差异均有高度统计学意义（P〈0.01）;单次透析后,HD＋HDF组和HD＋CRRT组Hcy、瘦素、AGEs以及iPTH均显著低于HD组[（37.3±19.9）μmol/L、（21.4±5.5）、（35.7±8.8）、（2.6±1.1）μg/L],差异均有统计学意义（P〈0.05）。治疗1年后,HD组瘦素[（25.7±4.3）μg/L]水平较1年前显著升高,差异有统计学意义（P〈0.05）,而HD＋HDF组和HD＋CRRT组Hcy[（26.3±8.1）、（26.9±7.4）μmol/L]、AGEs[（30.5±6.2）、（28.1±7.3）μg/L]及iPTH[（2.1±0.6）、（2.5±1.0）μg/L）]均显著下降,差异均有统计学意义（P〈0.05或P〈0.01）。1年后Hcy、AGEs、iPTH、及瘦素三组间比较差异有统计学意义（P〈0.05）。治疗1年后,HD组动脉粥样斑块面积显著增加,差异有统计学意义（P〈0.05）。Hcy、瘦素、AGEs及iPTH与颈动脉IMT呈正相关（r=0.48、0.80、0.73、0.41,P〈0.05或P〈0.01）,与粥样硬化斑块面积呈正相关（r=0.54、0.66、0.61、0.43,P〈0.05或P〈0.01）。结论常规HD不能有效清除尿毒症毒素,而HDF或CRRT能够有效清除相关毒素,并延缓颈动脉粥样硬化的过程。尿毒症毒素与动脉粥样硬化具有正?

Clear effect of HD,HDF and CRRT on uremic toxins and their impact on extent of atherosclerosis

Objective To discuss clear effect of HD, HDF and CRRT on uremic toxins and their impact on the extent of atheroselerosis. Methods From January to December 2013, 68 eases with uremia failure treated with blood purification therapy in Renmin Hospital of Wuhan University were selected and divided into HD group, HD＋HDF group and HD＋ CRRT group according to dialysis. Hey, leptin, AGEs and iPTH and IMT, atheroselerotic plaque area were compared in three groups. Results After a single dialysis, Hey [（21.8±5.3）, （21.6±7.2） μmol/L], leptin[（10.8±2.2）, （11.9±3.5） μg/L], AGEs [（25.8±4.1）, （20.2±2.6） μg]L] and iPTH [（1.7±0.6）, （1.7±0.5） μg/L] of HD＋HDF group and HD＋CRRT group were significantly decreased, the differences were statistically significant （P 〈 0.01）; after single dialysis, Hcy, leptin, AGEs and iPTH of HD＋HDF group-and HD＋CRRT group were significantly lower than HD group [（37.3±19.9） μmol/L, （21.4±5.5）, （35.7±8.8）, （2.6±1.1）μg/L], the differences were statistically significant （P 〈 0.05）. After 1 year of treatment, leptin levels [（25.7±4.3） μg/L]of HD group were significantly higher than that in a year ago, the differences was statistically significant （P 〈 0.05）, while Hey [（26.3±8.1）, （26.9±7.4）μmol/L], AGEs [ （30.5±6.2）, （28.1±7.3） μg/L] and iPTH [（2.1± 0.6）, （2.5±1.0） μg/L）] of HD＋HDF group and HD＋CRRT group were significantly decreased, the differences were statistically significant （P 〈 0.05 or P 〈 0.01）. After 1 year of treatment, Hey, AGEs and leptin among the three groups were compared,the differences were statistically significant （P 〈 0.05）. After 1 year of treatment, atherosclerotic plaque area of HD group significantly increased, the difference was statistically significant （P 〈 0.05）. Hcy, Leptin, AGEs and iPTH was significantly positively related to carotid IMT and atherosclerotic plaque area （r = 0.48, 0.80, 0.73, 0.41, P 〈 0.05 or P