高通量血液透析与血液透析滤过在慢性肾功能衰竭患者中的疗效对比

目的：探讨高通量血液透析与血液透析滤过在慢性肾功能患者中的疗效。方法：选取2007年3月~2010年6月在我院进行维持性血液透析患者52例并随机分为2组：高通量透析（HPD）（n=26）和血液透析滤过（HDF）组（n=26）。两组患者均每周透析2次，每次4h，对两组患者进行1年临床观察。比较两组治疗前、后尿毒症患者血肌酐、β2-微球蛋白（β2-MG）、血磷、PTH的清除作用及对血脂的影响。结果：两组患者KT/V及透析前后血BUN、Cr的下降率无显著性差异。HDF组透析1年后β2-MG较透析前增高（5．17±15．09）％，HPD组透析1年后132．MG较透析前下降（12．32±3．27）％，P〈0．01。HDF组透析1年后甲状旁腺激素较透析前增高（6．59±14．13）％，HPD组透析1年后甲状旁腺激素较透析前下降（19．07±5．27）％，P〈0．01。HPD、HDF两组血磷下降率分别为（56．44±14．83）％、（43．94±17．96）％，P〈0．05，HDF组患者透析1年后其血清甘油三酯（TG）水平相比于透析前血清TG水平上升了（22．42±9．52）％，HPD组1年后TG较透析前下降（23．81±9．93）％，P〈0．05。结论：高通量血液透析能有效清除β2-MG、甲状旁腺激素、对血磷的清除效果也优于血液透析滤过，对血脂代谢也有显著改善作用。

Investigation of Clinical Efficacy of High-Flux Hemodialysis and Hemodiafiltration in Patients with Maintenance Hemodialysis

Objective： To compare the clearance effect of of high-flux hemodialysis and hemodiafiltration in patients with mainte- nance hemodialysis. Methods： 52 patients with maintenance hemodialysis were randomly divided into two groups：high-flux hemodialysis （HPD） group （n=26）, hemodiafiltration （HDF） group （n=26）. All patients received dialysis twice a week, every time 4h, clinical efficacy was observed after one year treatment in two groups.Blood samples were taken for the detection of serum creatinine, β 2-microglobulin （β2-MG）, phosphorus, PTH scavenging and effects on blood lipids before and after the treatment. Results： The change of KT/V and the decreasing of serum BUN before and after dialysis was no significant difference in two groups of patients. HDF group after 1 year of dial- ysis compared with pre-dialysis β2-MG increased （5.17± 15.0 9） %, HPD group after 1 year of dialysis compared with pre-dialysis β2-MG decreased （12.32± 3.27） %, P 〈0.01. HDF group after 1 year of dialysis compared with predialysis intact parathyroid hormone increased （6.59± 14.13） %, HPD group after 1 year of dialysis compared with predialysis intact parathyroid hormone decreased （19.07± 5.27 ） %,, P 〈0.01. HPD, HDF Were two phosphorus decreased （5 6.44±14.83）%, （43.94 ± 17.96）%, P 〈0.05; HDF group 1 year after triglyceride （TG） more dialysis before the rise （22.42 ± 9.52）%, HPD group after 1 year compared with pre-dialysis TG decreased （2 3.81 ±9.93）%, P〈0.05. Conclusion： High-flux hemodialysis can effectively remove the β 2-MG, parathyroid hormone, and phosphorus than hemodialysis filtration, the effect on lipid metabolism is also a significant improvement.