目的 观察不同血液透析模式对尿毒症维持性血液透析(MHD)患者体内生长因子-15(GDF15)及左心功能的影响.方法 选择2017年6月至2018年6月在贵阳市第二人民医院就诊的 MHD＞3个月的慢性肾衰竭尿毒症患者120例.将患者按透析方式不同分为血液透析(HD)+血液滤过(HDF)+血液灌流(HP)组(每个月进行8次HD、每个月进行4次HDF、每个月进行1次HP)、HD+HDF组(每个月进行8次HD、每个月进行1次HDF)和HD组(每个月进行8次HD),每组40例.治疗前和治疗后6个月、1年采集患者静脉血,检测3组患者血清GDF-15水平;采用超声心动图检测3组患者左心室舒张期末内径(LVDD)、左心室收缩期末内径(LVDS)、左心室舒张期末容积(LVVD)、左心室收缩期末容积(LVVS)、左心室后壁厚度(LVPWT)、室间隔厚度(LVST)、舒张早期及晚期最大血流比(E/A)、左室射血分数(LVEF).结果 治疗后, 3组患者GDF-15水平及LVDD、LVDS、LVVD、LVVS、LVPWT、LVST、E/A均较治疗前明显降低,LVEF较治疗前明显升高(均P＜0.05);且HD+HDF+HP组治疗1年后的变化较HD+HDF组和HD组更显著〔GDF-15(ng):853.78±78.80比921.73±72.54、971.07±72.05,LVDD(mm): 48.25±1.25比50.67±1.26、51.69±1.33,LVDS (mm):35.21±1.01 比 37.84±0.90、38.91±0.83,LVVD(mL):101.44±4.40 比 109.27±6.47、115.11±5.46, LVVS(mL):35.75±1.52比37.75±1.70、39.48±1.48,LVPWT(mm):8.26±0.77比10.24±0.98、11.22±0.91, LVST(mm):9.07±0.48比10.47±0.61、11.60±0.58,E/A:1.03±0.05比1.07±0.06、1.15±0.08,LVEF:0.64±0.03比0.59±0.03、0.51±0.04,均P＜0.05〕.结论 不同透析模式组合能有效降低患者体内GDF-15水平,改善MHD患者左心功能,从而能减少心血管事件发生率.%Objective To study the effects of different hemodialysis modes on growth factor-15 (GDF-15) and left ventricular function in uremic patients undergoing maintenance hemodialysis (MHD). Methods One hundred and twenty uremic patients with chronic renal failure whose MHD > 3 months admitted to Guiyang Second People's Hospital from June 2017 to June 2018 were enrolled, and they were divided into a hemodialysis (HD)+ hemofiltration (HDF)+hemoperfusion (HP) group (HD 8 times per month, HDF 4 times per month, HP 1 time per month), a HD+HDF group (HD 8 times per month, HDF 1 time per month) and a HD group (HD 8 times a month) according to different dialysis modes, each group 40 cases. The patients' venous blood was collected before treatment and 6 months and 1 year after treatment, serum was separated, and the GDF-15 levels in the three groups were detected; the left ventricular end-diastolic dimension (LVDD), left ventricular end-systolic dimension (LVDS), left ventricular end-diastolic volume (LVVD), left ventricular end-systolic volume (LVVS), left ventricular posterior wall thickness (LVPWT), ventricular septal thickness (LVST), maximum blood flow ratio (E/A) of early to late diastole and left ventricular ejection fraction (LVEF) in three groups were detected by echocardiography. Results After treatment, the GDF-15 levels and LVDD, LVDS, LVVD, LVVS, LVPWT, LVST and E/A in the three groups were significantly lower than those before treatment, while LVEF was significantly higher than that before treatment (all P < 0.05); the changes after treatment in the HD+HDF+HP group were more significant than those in the HD+HDF group and HD group [GDF-15 (ng): 853.78±78.80 vs. 921.73±72.54, 971.07±72.05, LVDD (mm): 48.25±1.25 vs. 50.67±1.26, 51.69±1.33, LVDS (mm): 35.21±1.01 vs. 37.84±0.90, 38.91±0.83, LVVD (mL): 101.44±4.40 vs. 109.27±6.47, 115.11±5.46, LVVS (mL): 35.75±1.52 vs. 37.75±1.70, 39.48±1.48, LVPWT (mm): 8.26±0.77 vs. 10.24±0.98, 11.22±0.91, LVST (mm): 9.07±0.48 vs. 10.47±0.61, 11.60±0.58, E/A: 1.03±0.05 vs. 1.07±0.06, 1.15±0.08, LVEF: 0.64±0.03 vs. 0.59±0.03, 0.51±0.04, all P <0.05]. Conclusion The combined hemo- dialysis with different hemodialysis modes can effectively reduce the level of GDF-15 in uremic patients with chronic renal failure and MHD and improve their left ventricular function, thus the incidence of cardiovascular events and mortality in such patients can be decreased.
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