血液透析滤过、透析联合灌流、高通量透析治疗尿毒症难治性高血压的疗效比较

摘要

Objective:To compare therapeutic effects of hemodiafiltration (HDF) ,hemoperfusion combined hemodi‐alysis (HP+ HD) and high flux hemodialysis (HFHD) on uremic refractory hypertension (URH) .Methods :A total of 60 URH patients undergoing maintenance hemodialysis (MHD) were selected from three hospitals .They were randomly and equally divided into HDF group ,HP+ HD group and HFHD group .The 24h ambulatory blood pres‐sure ,concentrations of parathyroid hormone (PTH) andβ2‐microglobulin (β2‐MG) were detected and compared a‐mong three groups before ,after first treatment and 12 weeks after treatment .Results:Compared with before treat‐ment ,after the first treatment ,there were significant reductions in blood pressure ,blood concentrations of PTH andβ2‐MG in three groups , P< 0.05 or <0.01 ,and therapeutic effect was most significant in HP + HD group ;compared with after first treatment ,12 weeks later ,blood concentrations of PTH and β2‐MG further significantly reduced in three groups (P<0.05 or <0.01) ,compared with HDF group and HFHD group ,there was significant reductions in blood concentrations of PTH [(211.12 ± 50.05) pg/L ,(195.49 ± 48.32) pg/L vs .(75.43 ± 14.38) pg/L] andβ2‐MG [ (9.16 ± 5.02) mg/L ,(9.92 ± 5.37) mg/L vs .(5.39 ± 2.09) mg/L] in HP+ HD group , P<0.01 all .In HDF、HP+ HD、 HFHD groups ,the DBP were [ (86.70 ± 12.76) mmHg)、 (86.10 ± 9.84) mmHg)、(90.95 ± 10.15) mmHg] respectively ,those were return to normal mainly ,and no significant difference ,the SBP were [ (140.75 ± 10.85) mmHg)、(146.20 ± 8.31) mmHg)、(146.30 ± 9.65) mmHg) ,those were close to normal and no significant difference also .Adverse reactions were mild in three groups ,that of HDF group was significantly less than those of HP+ HD group and HFHD group [0 vs .40% ,45% , P<0.05 all] .Conclusion:HDF ,HP+ HD and HFHD could effectively remove blood PTH and β2‐MG ,and lower blood pressure in URH patients .Hospital may choose therapeutic plan according to specific needs of patients and HD room condition .%目的：对比血液透析滤过、透析联合灌流、高通量透析治疗尿毒症难治性高血压（URH）的疗效。方法：从三家医院共选择60例行维持性血液透析（MHD）的URH患者。随机均分为血液透析滤过（HDF）组、血液灌流（HP＋ HD）组和高通量透析（HFHD）组。治疗前、第一次、治疗12周后分别测定三组患者24h动态血压，甲状旁腺素（PTH）、β2‐微球蛋白（β2‐MG）的浓度。结果：三组第一次治疗后血压、血PTH、β2‐MG浓度均较治疗前有显著降低（P＜0.05或＜0.01），且HP＋ HD组效果最明显；12周后三组血PTH、β2‐MG浓度均较第一次治疗后明显降低（P＜0.05或＜0.01），且与HDF组和HFHD组比较， HP＋ HD组血PTH [（211.12±50.05） pg／L、（195.49±48.32） pg／L比（75.43±14.38） pg／L ]、β2‐MG [（9.16±5.02） mg／L、（9.92±5.37） mg／L比（5.39±2.09） mg／L]浓度降低更显著（P均＜0.01）；HDF组、HP＋ HD、HFHD组舒张压分别为[（86.70±12.76） mmHg）、（86.10±9.84） mmHg）、（90.95±10.15） mmHg]，无显著差异，基本恢复正常，收缩压分别为[（140.75±10.85） mmHg）、（146.20±8.31） mmHg）、（146.30±9.65） mmHg），无显著差异，接近恢复正常。三组患者的不良反应轻， HDF组显著少于HP＋ HD组和HFHD组[0比40％，45％， P均＜0.05]。结论：尿毒症难治性高血压患者接受血液透析滤过、透析联合灌流、高通量透析治疗，均能有效地清除血 PTH、血β2‐MG ，降低血压。可根据患者的具体需求及血透室条件选择治疗方案。