不同置换液量血液透析滤过对血透患者β2-MG、iPTH的影响

摘要

Objective To observe the clearance effect of hemodiafiltration (HDF) with different amount of substitute fluid on the β2-microglobulin (β2-MG) and parathyroid hormone (PTH) in hemodialysis patients.Methods 30 patients with dialysis time greater than 6 months were randomly divided into 3 groups (n=10):the patients in group A and B received one time post-dilution HDF and two times of hemodialysis every week,the substitute fluid of group A was 10-14.9 L,the substitute fluid of group B was 15-20 L.The patients in group C received 3 times of hemodialysis every week.After being observed continuously for 5 months,the blood density of β2-MG and iPTH were compared before and after the treatment in the 3 groups,and the improvement situation of the cutaneous pruritus was also observed.Results The blood density of iPTH and β2-MG had dropped obviously and the cutaneous pruritus also improved in the HDF groups,the changes were obvious in the high volume HDF group,the difference was statistically significant.The blood density of iPTH had mild drop in HD group,the difference was not statistically significant.The blood density of β2-MG had mild ascension.Conclusion Increasing the amount of substitute fluid could improve the clearance effect of HDF on β2-MG and iPTH in hemodialysis patients,and also improve the cutaneous pruritus.HDF is more superior than HD in cleaning iPTH and β2-MG.HD cannot eliminate β2-MG and iPTH effectively.%目的 观察不同置换液量血液透析滤过(HDF)对血透患者β 2-MG、iPTH的清除效果.方法 将30例透龄＞6个月血透患者随机分成A、B、C三组各10例,A、B两组接受每周1次血液透析滤过(HDF)治疗+每周2次血液透析(HD)治疗,A组置换液量为10 ～ 14.9 L,B组置换液量为15 ～ 20L,C组接受每周3次血液透析治疗.连续观察5个月,比较三组病人实验前后血β2-MG、iPTH浓度的变化,观察病人皮肤瘙痒的改善情况.结果 A、B两组实验后血β2-MG、iPTH均有下降,皮肤瘙痒也有改善,以B组改变最明显(P＜0.05).而C组实验前后iPTH浓度有轻度下降,但差异无统计学意义,β 2-MG浓度有轻度升高.结论 增加置换液量可以提高HDF治疗对血透患者β2-MG、iPTH的清除效果,并明显改善病人皮肤瘙痒症状,HDF治疗清除β2-MG、iPTH的效果优于HD.