不同频率血液灌流在维持性血液透析患者中的应用效果比较

目的探讨不同频率血液灌流(HP)对维持性血液透析(MHD)患者血清溶质的清除效果,为临床合理应用HP提供实践依据。方法采用便利抽样法,选择2019年1—10月在首都医科大学附属北京友谊医院血液净化中心行MHD的132例患者,随机分为A、B、C、D 4组。A组行高通量血液透析,B、C、D组在A组基础上分别加HP 2周1次、1次/周和2次/周,观察12周。比较4组的钙、磷、甲状旁腺激素(PTH)、C反应蛋白(CRP)、β2-微球蛋白(β2-MG)、丙二醛(MDA)等血清溶质指标以及凝血功能情况。结果D组有2例患者分别于第6、10周未完成规定方案频次HP被剔除,原因均为消化道出血,最后共31例患者完成本研究;A、B、C 3组无出血情况且所有患者均完成本研究。干预后B、C、D3组的磷、PTH、CRP、β2-MG、MDA指标均低于A组,4组比较差异均有统计学意义(P<0.05);B组干预后的钙、磷、CRP指标低于干预前,差异有统计学意义(P<0.05);C组、D组干预后的钙、磷、CRP、PTH、β2-MG、MDA指标均低于干预前,差异有统计学意义(P<0.05)。SNK-q检验显示,血钙除C组与D组外,其余两两比较差异均有统计学意义(P<0.05);血磷仅A组与C组、A组与D组差异有统计学意义(P<0.05);PTH、CRP、β2-MG、MDA 4种溶质中,A组与B组、C组与D组差异无统计学意义(P>0.05),其余两两比较差异均有统计学意义(P<0.05)。C组干预后的凝血酶原时间高于干预前,差异有统计学意义(P<0.05);D组干预后凝血酶原时间、部分凝血活酶时间及纤维蛋白原均高于干预前,差异有统计学意义(P<0.05)。干预后,D组的凝血酶原时间、部分凝血活酶时间及纤维蛋白原均高于A、B、C组,差异有统计学意义(P<0.05)。结论高通量血液透析基础上联合HP更有利于清除患者体内的中大分子血清溶质,1次/周即可达到较好效果。HP频率过高可能有出血风险及费用过高弊端。

Comparison of the application effect of different frequency hemoperfusion in maintenance hemodialysis patients

Objective To explore effects of hemoperfusion(HP)with different frequencies on the clearance of serum solutes in patients with maintenance hemodialysis(MHD),and to provide a practical basis for the reasonable clinical application of HP.Methods By the convenient sampling method,a total of 132 patients who underwent MHD in Blood Purification Center of Beijing Friendship Hospital Affiliated to Capital Medical University were selected as research objects from January to October 2019 and they were randomly divided into group A,group B,group C and group D.Group A received high-flux hemodialysis.On the basis of group A,HP was added to group B,group C and group D respectively for once every 2 weeks,once per week and twice per week.They were observed for 12 weeks.The serum solute indexes such as calcium,phosphorus,parathyroid hormone(PTH),C-reactive protein(CRP),β2-microglobulin(β2-MG)and malondialdehyde(MDA)and coagulation function were compared among the four groups.Results In group D,2 patients failed to complete the HP frequency of the prescribed plan in the 6th and 10th weeks respectively and were excluded,and the reasons were both gastrointestinal bleeding.Finally,a total of 31 patients in group D completed the study.All patients in group A,B and C were without bleeding and completed the study.After intervention,the indexes of phosphorus,PTH,CRP,β2-MG and MDA in groups B,C and D were lower than those in group A,and the differences among the 4 groups were statistically significant(P<0.05).The calcium,phosphorus and CRP indexes of group B after intervention were lower than before intervention,and the differences were statistically significant(P<0.05).The indexes of calcium,phosphorus,CRP,PTH,β2-MG and MDA after intervention in group C and group D were all lower than before intervention,and the differences were statistically significant(P<0.05).SNK-q test showed that except for group C and group D,there were statistically significant differences in blood calcium between the other two groups(P<0.05).There were statistically significant differences in blood phosphorus between group A and Group C and between group A and Group D(P<0.05).Among the 4 solutes including PTH,CRP,β2-MG and MDA,there was no statistically significant difference between group A and group B,and between group C and group D(P>0.05),while other pair comparisons showed statistically significant differences(P<0.05).The prothrombin time in group C after intervention was higher than that before intervention,and the difference was statistically significant(P<0.05).The prothrombin time,partial thromboplastin time and fibrinogen after intervention in group D were all higher than those before intervention,and the differences were statistically significant(P<0.05).After intervention,the prothrombin time,partial thromboplastin time and fibrinogen in group D were higher than those in groups A,B,and C,and the differences were statistically significant(P<0.05).Conclusions The combination of HP on the basis of high-flux hemodialysis is more conducive to clearing the serum solutes of medium and large molecules in patients,and better results can be achieved with the frequency of once a week.Excessive HP frequency may have the disadvantages of bleeding risk and high cost.