血液透析及血液透析滤过对维持性血液净化治疗患者慢性并发症的影响

目的探讨血液透析及血液透析滤过对维持性血液净化治疗患者慢性并发症的影响。方法选择37例稳定维持性血液净化治疗时间大于1年的患者，随机分为HD、HDF组，分别应用血液透析及血液透析滤过治疗1年，观察并比较血压、血红蛋白、白蛋白、血脂、全段甲状旁腺激素、尿素清除率指数（Kt／V）、血钙、磷及血β2微球蛋白清除率的变化。结果血液透析及血液透析滤过对小分子物质清除差异无统计学意义（P〉0．05）。血液透析滤过治疗1年后，患者血红蛋白由（102．5±17．2）g／L升至（111．4±12．3）g／L，全段甲状旁腺激素由（627．7±571．9）Pg／ml下降到（489．6±372．4）Pg／ml，透析前平均动脉压由（110．7±6．8）mmHg下降到（106．8±7．2）mmHg，高密度脂蛋白由（0．92±0．23）mmol／L上升至（1．03±0．27）mmoL／L，差异均有统计学意义（P〈0．05）；而血液透析患者上述指标无明显变化。血液透析滤过血B2微球蛋白清除卒为（37．1±4．1）％，单纯血液透析患者血β2微球蛋白清除率无明显变化。结论血液透析滤过有利于清除中分子物质，改善血液净化患者的肾性贫血、高血压和继发性甲状旁腺功能亢进。

The influence of hemodialysis and hemodiafiltration on chronic complications in maintenance blood purification patients

Objective To investigate the influence of hemodialysis and hemodiafihration on chronic complications in maintenance blood purification patients. Metheds 37patients aged from 28 to 69 years and with maintenance blood purification more than one year were switched to hemodiafiltration for one year. The clinical and biochemical indicators, including blood pressure,hemoglobin, albumin, lipids, intact parathyroid hormone （ iPTH）, calcium, phosphorus, Kt/V and 132 - MG clearance rate,were obtained before and after the application of hemodiafihration. Results After hemodiafihration for one year, hemoglobin increased from （ 102.5 ±17.2 ） g/L to （ 111.4 ±12.3 ） g/L, iPTH declined from （ 627.7 ±571.9 ） Pg/ml to （489.6 ± 372.4） Pg/nd（P 〈0. 05） ,mean arterial blood pressure lowered from （ 110.7 ±6. 8） mm Hg to （ 106. 8 ±7.2） mm Hg（P〈0. 05） ,and high -density lipoprotein（HDL） increased from （0. 92 ±0. 23） mmoL/L to（l. 03 ±0. 27） mmol/L （ P 〈 0. 05 ）. There were no significant differences in clearance rates for small molecules between hemodialysis and hemodiafiltration. 132 - MG clearance rate was （37.1 ±4. 1 ） % after one hemodiafihration seesion, butβ2 - MG clearance rate was no significant differences after one hemodialysis. Conclusion Hemodiafihration could efffectively improve 132 - MG clearance, renal anemia,hypertension,and secondary hyperparathyroidism in maintenance blood purification patients.