高、低通量血液透析及联机血液透析滤过清除溶质的效果比较

目的比较联机血液透析滤过(OL-HDF)、高通量血液透析(HF-HD)以及低通量血液透析(LF-HD)3种血液净化方式对尿毒症患者不同分子量毒素清除的效果。方法总共 25例长期常规血透患者进入本研究。所有患者分别接受上述3种方式血液净化治疗,每周3次,每次4 h,血流量230 ml/min,透析液流量500 ml/min。OL-HDF置换液为前稀释,流量150 ml／min, 平均置换液量36 L,透析液流量为700 ml／min,流经透析器透析液流量为550 ml／min。所有患者净脱水量根据病情需要约为体重的3％-5％。每1种方案治疗时间为4-6周,间隔2～3周,间隔期行常规HD治疗。测定治疗前后患者Scr、BUN及β2-MG、iPTH等水平,同时计算出其清除百分率。结果 LF-HD、HF-HD、OL-HDF治疗组Scr和BUN清除率分别为:72．4％±4．0％,70．6％±3％,71．7％±3．6％和75．1％±5％,73．0％±4%,76．2％±4％,3种治疗间的差异无统计学意义。血β2-MG及iPTH在LF-HD治疗前后无显著差异,而在HF-HD及OL-HDF组中,β2-MG治疗前后的清除率分别为32．5％±7％和44．2％±10％;iPTH清除率分别为42．7％±9．2％和54．4％± 8．8％,两组治疗前后溶质浓度及两组间清除率差异均有统计学意义(P均<0．05)。结论 3种血液净化治疗方式对小分子溶质清除效果基本相似。LF-HD对相对分子质量大于9500的中大分子β2-MG、iPTH清除效果不明显,而HF-HD及OL-HDF能有效地清除上述两种中大分子溶质,其中OL-HDF的清除率更高

Comparison of the efficacy of removing solutes among on-line hemodiafiltration, low- and high-flux hemodialysis

Objective To evaluate the impact of OL-HDF on in vivo removal of a wide spectrum of solutes (urea， creatinine， iPTH and β2-microglobulin) in comparison to LF-HD and HF-HD. Methods Twenty-five patients(17 men，8 women)were studied. Every patient underwent three dialysis sessions with routine HD parameters. Effects were compared among 1.8 m2 polysulfone LF-HD，1.8 m2 polysulfone HF-HD and OL-HDF. Predialysis and postdialysis solute concentrations were measured.The percentage of reduction ratios for each solute were calculated. Results Urea (molecular mass of 60 daltons)and creatinine(molecular mass of 113 daltons)reduction ratios were similar in LF-HD， HF-HD and OL-HDF. B2-microglobulim and iPTH reduction ratios for LF-HD were negligible. Mean β2-microglobalin reduction rates were 32.5%±7.0% for HF-HD versus 44.2%±10% for OL-HDF.(reinfusion volume mean 36 L/session； P < 0.05).Mean iPTH reduction rates were 42.7%±9.2% and 54.4%±8.8% for HF-HD and OL-HDF， respectively(P < 0.05).Conclusion Removal of solutes with small molecular weight is similar in three type therapies of hemopurification techniques. LF-HD does not seem to remove solutes with a molecular weight greater than 9500 daltons.OL-HDF provides marked enhancement of convection volume and enables a significant increase in β2-microglobulin and iPTH removal. β2-microaglobulin extraction is almost nil with LF-HD， better with HF-HD， and more effective with OL-HDF.