不同血液透析方式对尿毒症患者营养状况的影响

目的比较高通量血液透析(high flux hemodialysis,HFHD)与低通量血液透析(conventional hemodialysis,HD)联合血液透析滤过(combining hemodiafiltration,HDF)治疗对尿毒症患者营养状态的影响。方法便利抽样法选取2013年6-12月,在第二军医大学长征医院肾内科维持性血液透析(maintenance hemodialysis,MHD)患者55例为研究对象,按随机数字表法将其分为观察组(高通量血液透析,3次/周)和对照组(低通量血液透析2次/周+血液透析滤过1次/周)。随访6个月,进入试验前1周内(基线期)及开始试验后6个月测量患者透析前血常规、肝肾功能、电解质、全段甲状旁腺素(intact parathyroid hormone,iPTH)、β2微球蛋白(β2-microglobulin,β2-M)、C反应蛋白(C-reactive protein,CRP),观察人体测量学指标、主观综合营养评估及不良事件的发生情况。结果基线期两组患者血清β2-M及血磷的差异无统计学意义,但第6个月观察组患者血磷值显著低于基线期,差异有统计学意义(P0.01)。两组患者在其他实验室检查项目、人体测量学指标、主观综合营养评估上的差异均无统计学意义(均P0.05)。观察组有2例患者试验初出现透析器凝血,1例患者透析中出现轻度过敏。对照组有3例出现透析中低血压。结论两种透析方式长期疗效可能是相当的,HFHD组血压的控制及血磷的清除更好,且对营养状态没有影响。

Effect of Different Hemodialysis Methods to Nutritional Status of Patients with Uremia

Objective To compare the effect of high-flux hemodialysis and conventional hemodialysis com-bined hemodiafiltration to nutritional status of patients with uremia.Methods Totally fifty-five mainte-nance hemodialysis（MHD）patients were randomly selected and divided into experimental group（high-flux hemodialysis,3 times/week）and the control group （low-flux blood dialysis 2 times/week＋hemodiafiltra-tion 1/weeks）,followed up for 6 months.Blood routine,liver and kidney function,electrolytes,intact para-thyroid hormone （iPTH）,β2-microglobulin（β2-M）,C-reactive protein （CRP）were measured 1 week before treat-ment and 6 months after treatment.Anthropometry index,subj ective global assessment and incidence of adverse situation were observed.Results There was no statistic significance ofβ2-M and blood phosphorus between two groups of patients in base line period,while the blood phosphorus index in experimental group was lower than base line in the sixth month（P〈0.01）.There was no statistic significance of other laboratory examination item,anthro-pometry index,subjective global assessment between two groups of patients （all P〉0.05）.There were 2 ca-ses of patient in observation group had dialyzer blood coagulation at the very begin of the experiment,and 1 case with mild allergy.3 cases in control group had hypotension during hemodialysis.Conclusion The long-term efficacy of the two dialysis pattern may be considerable,HFHD group have better blood pressure control and phosphorus removal and with no influence in nutrition state.