不同血液净化方法对维持性血液透析患者毒素清除力的影响分析

目的 分析不同血液净化方法对维持性血液透析(maintenance hemodialysis,MHD)患者毒素清除力的影响。 方法 将2015年1月—2018年4月于无锡新吴区新瑞医院行血液净化治疗的80例MHD患者按随机数字表法设低通量血液透析(low-flux hemodialysis,LFHD,25例)、高通量血液透析(high flux hemodialysis,HFHD,31例)、血液透析滤过(hemodiafiltration,HDF,24例);血液净化方式分别为LFHD、HFHD、HDF;比较3组毒素清除力。 结果 ①3组小分子溶质清除情况比较差异无统计学意义(P>0.05);②治疗后2组血清尿素氮(urea nitrogen,BUN)、马尿酸(hippuric acid,HA)、硫酸对甲苯酚(p-cresol sulphate,PCS)、硫酸吲哚酚(indoxyl sulphate,IS)浓度较治疗前均显著下降,但3-羧基-4-甲基-5-丙基-2-呋喃丙酸(3-carboxy-4-methyl-5-propyl-2-furan-propionic acid,CMPF)未见显著变化,且血清浓度组间差异无统计学意义(P>0.05);2组HA、PCS、IS、CMPF下降率及HA、PCS、IS蛋白结合类毒素溶质清除总量比较差异均有统计学意义(均P<0.05),且HDF组HA、PCS、IS、CMPF下降率及HA、PCS、IS蛋白结合类毒素溶质清除总量显著高于LFHD组、HFHD组(均P<0.05)。 结论 LFHD、HFHD、HDF均有一定毒素清除力,但HDF对HA、PCS、IS、CMPF的清除能力更显著,值得临床重视。 

Effect analysis of different blood purification methods on the toxin elimination capacity of patients with maintenance hemodialysis

Objective To analyze the effect of different blood purification methods on the toxin elimination capacity of patients with maintenance hemodialysis(MHD). Methods Total 80 patients with MHD treated with blood purification in our hospital from January 2015 to April 2018 were divided into low-flux hemodialysis(LFHD) group(n=25), high-flux(HFHD) group(n=31) and hemodiafiltration(HDF) group(n=24) according to the random number table method. The toxin elimination capacity was compared among the three groups. Results ①There was no statistically significant difference in solute clearance among the three groups(P>0.05). ② After treatment, concentrations of serum urea nitrogen(BUN), hippuric acid(HA), p-cresol sulphate(PCS) and indoxyl sulphate(IS) in both groups were significantly decreased. However, there was no obvious change in 3-carboxyl-4-methyl-5-propyl-2-furan-propionic acid(CMPF), and there was no statistically significant difference in the concentration of serum solute among all groups(P>0.05). There were statistically significant differences in declines of HA, PCS, IS and CMPF and the total removal amount of protein-binding toxoid solutes among the three groups(all P<0.05). Besides, the declines of HA, PCS, IS and CMPF and the total removal amount of protein-binding toxoid solutes in HDF group were significantly higher than those in LFHD group and HFHD group(all P<0.05). Conclusion LFHD, HFHD and HDF all can remove toxin, but HDF can clear HA, PCS, IS and CMPF more obviously, which is worthy of clinical attention.