Objective To investigate whether the combination of maintenance hemodialysis (MHD) with hemoperfusion (HP) improves left ventricular function in MHD patients. Methods This study was a prospective, randomized, controlled clinical trial. Fifty-nine MHD patients were selected and randomly divided into two groups. Group HD was given hemodialysis (HD) 3 times a week, and group HP+HD received HD 2 times a week and HD combined with HP once a week. This study lasted for 6 months. Left ventricular structure and function of the patients were measured by echocardiography before and after the study. Clinical and laboratory data were also collected. Results Before the study, there were no differences in antihyperten-sive drugs, systolic blood pressure (SBP), diastolic blood pressure (DBP), serum concentrations of CRP, iPTH and β2-MG, and left ventricular mass index (LVMI) between the two groups. At the end of the six months observation, serum β2-MG and LVMI decreased significantly in group HD+HP (P =0.017 and 0.035, respectively), but showed no differences in group HD. There is a positive correlation between serum β2-MG level and LVMI in group HD+HP (P=0.034). Conclusion MHD combined with HP could reduce LVMI in MHD patients, probably due to the better clearance of middle and large molecular uremic toxins.%目的 在维持性血液透析(maintenance hemodialysis,MHD)患者中,左心室功能和患者的预后明显相关.本研究欲探讨在常规血液透析的患者中,联合血液灌流是否能影响患者的左心室功能. 方法 59例MHD患者,随机分为2组,单纯血液透析组(HD,3次/周,4h/次)30人,血液透析联合血液灌流组(HP+HD,每周1次血液灌流联合血液透析+2次常规血液透析)29人,于治疗前及治疗6个月后经超声心动图测定患者左心室功能指标并计算左心室质量指数(LVMI),同时记录患者相关的临床和血液理化指标. 结果 2组患者入选时基本临床指标、血清β2微球蛋白(β2-MG)、全段甲状旁腺激素(iPTH)水平和左心室功能指标差异无统计学意义(P＞0.05).治疗6个月后,HD组患者左心功能指标、血清β2MG及PTH水平与治疗前比较差异无统计学意义(P＞0.05),HD+HP组患者心脏结构和功能较前改善,患者的血清β2-MG水平和LVMI较治疗前明显降低(P值分别为0.017和0.035),2者呈明显正相关(r=0.339,P=0.034).结论 维持性血液透析患者同时联合血液灌流治疗有助于减轻其左心室结构和功能损害,其机理可能是由于一些中大分子的尿毒症毒素被清除的缘故.
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