平衡型氨基酸透析液血液透析治疗临床应用观察

目的设计平衡型氨基酸透析液，应用于维持性血液透析患者常规血液透析治疗，观察临床应用效果。方法选用解放军总医院第一附属医院长期维持性血液透析患者29例，透析2～3次／w，实验采用自身交叉对照设计，使用碳酸氢盐透析液1月后，再应用平衡型氨基酸透析液1月，分别观察血液生化指标、血浆蛋白、肾功能以及炎症指标的变化。结果血浆氨基酸谱显示绝大部分游离氨基酸及总游离氨基酸含量均恢复到与健康人相仿的水平；平衡型氨基酸透析液治疗后尿素氮、肌酐、尿酸等。肾功能指标有不同程度的升高，但电解质及钙、磷没有明显的变化；血浆总蛋白（TP）、白蛋白（ALB）、前白蛋白（PreA）、转铁蛋白（Trf）等较前无明显变化，但β2微球蛋白（β2-MG）和超敏C反应蛋白（SCRP）则较应用前有明显的降低（P〈0．01和P〈0．05）。结论平衡型氨基酸透析液能减少维持性血液透析患者的氨基酸丢失，部分改善其体内的氨基酸代谢紊乱，同时有可能减轻体内的微炎症反应。

Clinical observation of dialysate containing balanced amino acids used in maintenance hemodialysis patients

Objective To investigate the effect of dialysis using the dialysate containing balanced amino acids in maintenance hemodialysis patients. Methods We treated 29 maintenance hemodialysis patients with the dialysate containing balanced amino acids for dialysis for one month. Serum free amino acids, plasma proteins, inflammation markers, BUN, creatinine and electrolytes were measured before and after the treatment. Results In the patients using this dialysate for dialysis for one month, their serum concentrations of most free amino acids as well as total amino acids elevated to normal levels, but serum BUN, creatinine and uric acid increased. Their serum electrolytes, calcium, phosphate, total protein, albumin, prealbumin and transferrin remained unchanged, and serum β2-microglobulin and sensitive C reactive protein （SCRP） decreased significantly （P 〈0.05）. Conclusion Dialysis using the dialysate containing balanced amino acids prevents the loss of amino acids, partially improves disturbances of amino acid metabolism, and reduces micro-inflammation in maintenance hemodialysis patients.