高通量血液透析对维持性血液透析患者高同型半胱氨酸血症和左心室结构的影响

摘要

Objective To investigate the effects of high flux hemodialysis (HFHD) on hyperhomocysteinemia and left ventricular structure in maintenance hemodialysis (MHD) patients.Methods A prospective and grouping control study was conducted.From November 2014 to November 2015,a total of 45 hemodialysis patients with hyperhomocysteinemia were selected,and divided into the HFHD group (n =23) and the low flux dialysis (LFHD) group (n =22).Hcy was determined before and 6 months after treatment.At the same time,the left ventricular structure and function were estimated by color Doppler ultrasonic instrument,and the side effects were recorded.Results After the treatment,Hey level was reduced from (24.63 ± 7.21) μmol/L to (12.06-± 5.24) μmol/L in HFHD group,and that from (26.01 ± 8.17) μmol/L to (16.15 ± 6.21) μmol/L in LFHD group.There was significant difference between the two groups (P＜0.05).There were significant differences between two groups in the root diameter of pulmonary artery,left ventricular and diastolic diameter,anterior and posterior diameter of left atrium,right ventricular anterior and posterior diameter,left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF) (P＜0.05),but there was no significant difference in IVST between two groups (P＞0.05).No serious adverse events were observed.Conclusions HFHD can clear Hcy effectively,and improve the left ventricular structure in MHD patients.It's worthy of popularization and application.%目的 观察高通量血液透析(high-flux hemodialysis,HFHD)对维持性血液透析(maintenance hemodialysis,MHD)患者高同型半胱氨酸血症(hyperhomocysteinemia,HHcy)和左心室结构及功能的影响.方法 采用前瞻性、分组对照的方法,选择2014年11月至2015年11月武警四川省总队医院血液净化中心伴有HHcy的MHD患者45例,随机分成高通透析组23例和低通透析组22例.治疗6个月后,比较分析2组患者治疗前后血浆同型半胱氨酸(homocysteine,Hcy)的变化;应用彩色多普勒超声诊断仪测定患者左心室形态结构及功能.观察并记录不良反应.结果 治疗后高通透析组Hcy由(24.63±7.21) μmol/L降至(12.06±5.24) μmol/L,而低通透析组由(26.01±8.17)μmol/L降至(16.15±6.21) μmol/L;2组治疗后比较,高通透析组明显低于低通透析组,差异有统计学意义(P＜0.05).治疗后高通透析组与低通透析组超声心动图比较,肺动脉根部内径[(21.5±5.3) mm比(30.6±4.8) mm]、左室舒张末内径[(54.8±6.2) mm比(61.5±4.9) mm]、左房前后径[(31.9±5.7) mm比(50.3±7.3) mm]、右室前后径[(19.8±3.7) mm比(25.4±5.4) rmm]、左心室心肌重量指数[(92.1±12.6)g/m2比(98.6±9.7)g/m2]及左心室射血分数[(71.5±12.3)％比(53.8±14.8)％],差异均有统计学意义(P＜0.05);而室间隔厚度[(10.9±1.9) mm比(12.1±3.1)mm],差异无统计学意义(P＞0.05).2组患者治疗期间无明显不良反应.结论 HFHD能有效清除伴有HHcy的MHD患者Hcy,改善患者左心室结构及功能,值得临床广泛使用.