不同透析方案对透析患者瘦素水平和营养状况影响的对比研究

目的研究不同透析方案维持透析患者瘦素水平的差别.方法慢性肾衰竭维持血液透析患者65例,分为HD组与HD/HDF组,HD组进行常规碳酸氢盐血液透析,HD/HDF组每周3次常规血液透析同HD组,每月一次血液透析滤过(HDF)代替HD.对两组患者各营养指标进行检测.分别于HD、HDF前抽取自凝血检测瘦素、透析后查瘦素.并于HD、HDF开始5min后留取透析器入口及出口处血标本送检,检测瘦素浓度,计算溶质清除率.血清瘦素浓度测定采用ELISA法.透析后瘦素经超滤量校正,前后配对t检验,P<0.05有显著性差异.结果健康对照组、HD组、HD/HDF组女性瘦素水平显著高于男性.HD前后瘦素水平无显著性差异,HDF后瘦素水平明显下降.透析前HD/HDF组患者瘦素水平高于HD组.HDF中瘦素清除率显著高于HD[(27.6±19.8)ml/min vs (4.87±28.40)ml/min,P<0.001],透析前后下降率HDF组明显高于HD组[(29.33±20.21)% vs (5.14±36)%,P<0.005].HD/HDF组患者血白蛋白、前白蛋白、血红蛋白、体重指数及营养状况调查表积分均优于HD组,并且HD/HDF组EPO用量和输血量低于HD组.结论 HDF能有效清除瘦素,HD不能.一定程度的瘦素水平升高是营养状况改善的表现.

Clinical study of the nutrition and serum leptin level in maintainance hemodialysis patients of different dialysis modalities

Objective To study the nutrition and serum leptin level in maintenance hemodialysis patients of different dialysis modalities. Metheds 65 patients who started renal replacement therapy on HD or HD/HDF between 1997 and 2002 were considered.40 patients were treated with HD,the other 25 patients with HD/HDF(HD and HDF once a month). The serum Alb,PA,BUN,leptin were measured. The serum leptin concentration of HD/HDF patients were compared with those of HD patients and control human-beings.Clearance and reduction rate of leptin were analyzed,and the correlation between leptin and other nutrition index were evaluated. Results Leptin level was significant higher in female patients than in male patients of group HD?HD/HDF and control group.Serum leptin level was significant lower after HDF,but not after HD. Serum leptin concentrition of HD/HDF patients was higher than that of HD patients,controlled human-being. Clearance and reduction rate of leptin group HDF were significant greater than that in group HD.Nutrition status,dosage of blood transfusion and erythropoietin of group HD/HDF are better than that of group HD. Serum leptin level showed significant positive correlation with BMI and PAB in all patients. Conclusion On-line HDF can clear part of leptin but HD can not.The elevated serum leptin concentrition of HD/HDF patients may due to improved nutrition status.