组合人工肾、血液透析滤过、高通量透析对尿毒症脑病患者中大分子毒素清除效果观察

摘要

Objective: to compare the combination of artificial kidney dialysis, blood filtration, high flux dialysis three blood purification in patients with uremia encephalopathy in macromoleculett oxins removal effect.Methods: Choosed regular dialysis uremic encephalopathy patients 150 cases, observed during treatment were discontinued oral calcium and vitamin D or its analogues, in three times a week, on the basis of regular hemodialysis were randomly divided into: it dialysis filtration (HDF) group, the combination of artificial kidney group (HD+HP), high flux dialysis group (HFHD), 50 cases each.Hemodialysis group were performed three times a week, the dialysate calcium concentration tendency for 1.5mmol/L, the top 2 times for the common dialysis, 3 times with HDF, HD + HP or HFHD, 4 h/time.First before treatment, after the first treatment, 8 weeks after treatment, extraction of three groups of patients with blood specimens respectively, detection of blood routine, blood iPTH,β2-MG,electrolyte, etc.Results: three groups of patients iPTH, β2-MG,blood phosphorus levels in the first time after treatment than before treatment significantly reduced (P< 0.05), and HD+HP group effect was most obvious, serum creatinine, blood urea nitrogen, blood calcium, albumin, hemoglobin, including 1 time after treatment compared with 8 weeks after treatment there was no statistically significant difference (P>0.05).Three groups of patients iPTH,β2-MG, blood phosphorus levels in 8 weeks after treatment were significantly reduced after the first treatment (P< 0.05), and compared with HDF group and HFHD group, group combination artificial kidney blood iPTH, beta 2-microglobulin concentrations decrease level was the most obvious (P< 0.05).Conclusion: uremia encephalopathy patients HDF,HD+HP,HFHD can effectively remove blood iPTH,β2-MG,blood phosphorus, with HD+HP group to remove the most obvious effect.%目的:对比组合人工肾、血液透析滤过、高通量透析三种血液净化模式对尿毒症脑病患者中大分子毒素清除效果.方法:选择规律透析的尿毒症脑病患者150例,治疗期间均停止口服钙剂及维生素D或其类似物.将其随机分为透析滤过组(HDF)、组合人工肾组(HD+HP)、高通量透析组(HFHD)各50例.各组均行每周3次的血液透析,透析液钙浓度1.5mmol/L,其中每周前2次为普通透析,第3次用HDF、HD+HP或HFHD的模式,4h/次.第1次治疗前和治疗后、治疗8周后,分别抽取三组患者的血标本,检测血常规、血iPTH、β2-微球蛋白(β2-MG)水平、电解质等.结果:三组患者iPTH、β2-MG、血磷水平在第1次治疗后均较治疗前显著降低(P<0.05),且HD+HP组效果最明显,血肌酐、尿素氮、血钙、白蛋白、血红蛋白等第1次治疗后与治疗8周后相比差异无统计学意义(P>0.05).三组患者iPTH、β2-MG、血磷水平在治疗8周后均较第1次治疗后显著降低(P<0.05),且与HDF组和HFHD组比较,HD+HP组血iPTH、β2-MG浓度下降水平最明显(P<0.05).结论:尿毒症脑病患者接受血液透析滤过、组合型人工肾、高通量透析治疗,均能有效地清除血iPTH、β2-MG、血磷,以HD+HP清除效果最明显.