【摘要】 目的比较不同透析膜和不同膜面积的透析器对维持性血液透析(maintenance hemodialysis,MHD)患者骨矿物质代谢及微炎症状态的影响。方法选择MHD患者40例,随机分为3组:FX组16例(使用德国Fresenius公司FX60型高通量透析器,膜面积1.3m2)、TS组14例(使用日本Toray公司TS-1.3S型高通量透析器,膜面积1.3m2)、CA组10例(使用美国Baxter公司CA-HP-170型低通量透析器,膜面积1.7m2),全部患者每周透析3次,每次4h。比较入组前和治疗3个月、6个月后血清尿素氮(BUN)、肌酐(Cr)、尿酸(Ua)、白蛋白(ALB)、钙(Ca)、磷(P)、甲状旁腺激素(iPTH)、β2微球蛋白(β2-MG)、超敏C反应蛋白(Hs-CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、丙二醛(MDA)和超氧化物歧化酶(SOD)浓度变化。结果各组患者血清BUN、Cr、Ua、P、iPTH、Hs-CRP和IL-6治疗前后无明显差异(P>0.05);β2-MG在3个月、6个月时与基础值比较各组均明显下降(P<0.05),且在治疗6个月时TS组下降最显著(χ2=10.011,P=0.007);3个月时ALB各组均有上升趋势,但6个月CA组明显下降(P<0.05);TNF-αCA组升高,FX组和TS组下降(P<0.05);CA组MDA明显升高(P<0.05),SOD虽有下降趋势,但无统计学意义(P>0.05);FX组和TS组MDA明显下降(P<0.05),且TS组下降更显著(Z=-3.284,P=0.001),SOD3个月即开始下降(P<0.05),6个月与3个月时比较进一步下降(P<0.05)。结论①高通量透析器尽管膜面积较小,但对小分子毒素清除效果与大面积低通量透析器相当。②高通量透析可抑制氧化应激、改善微炎症状态,维持营养平衡。③对预防透析相关淀粉样变,除选用优质透析器外,提高透析液质量和避免各环节污染十分重要。更多还原

【Abstract】 Objective The aim of this study is to compare the effect of three dialyzers with different dialysis membranes and membrane area on mineral metabolism and micro-inflammation status of maintenance hemodialysis(MHD)patients.Method 40 MHD patients were recruited and randomly assigned to 3 groups:16 patients in FX group(German Fresenius company FX60 high-flux dialyzer,membrane area of 1.3 m2),14 patients in TS group(Japanese TORAY company TS-1.3S high-flux dialyzer,membrane area of 1.3 m2),10 patients in CA group(United States Baxter company CA-HP-170 low-flux dialyzer,membrane area of 1.7 m2).All patients received four-hour dialysis three times per week.Serum level of urea nitrogen(BUN),creatinine(Cr),uric acid(Ua),albumin(ALB),calcium(Ca),phosphorus(P),intact PTH(iPTH),beta2-micro-globulin concentration(β2-MG),high-sensitive C-reactive protein(Hs-CRP),superoxide dismutase(SOD),interleukin-6(IL-6),malondialdehyde(MDA),tumor necrosis factor-α(TNF-α),at baseline and the end of 3rd and 6th month were compared.Results There is no significant change in serum levels of BUN,Cr,Ua,P,iPTH,Hs-CRP and IL-6 from baseline to the end of 3rd and 6th month(P>0.05).In all groups serum levels of β2-MG decreased significantly at the end of 3rd and 6th month(P<0.05),and at the end of 6th month the level of β2-MG decreased the most in TS group(χ 2 =10.011,P=0.007).In all groups serum levels of ALB increased at the 3rd month,but in CA group it decreased significantly at the 6th month(P< 0.05).Serum level of TNF-α increased in CA group while decreased in FX group and TS group(P<0.05).In CA group serum level of MDA increased significantly(P<0.05),level of SOD decreased insignificantly.In FX group and TS group serum levels of MDA decreased significantly(P<0.05),and it decreased more in TS group(Z=3.284,P=0.001),serum levels of SOD in FX and TS group decreased significantly at 3th month(P<0.05),and they both further decreased significantly from the 3rd to the 6th month(P<0.05).Conclusion Small-area high-flux dialysis is comparable with low-flux hemodialysis on the removing of small molecular uremic toxins.High-flux dialysis may improve micro-inflammation state,reduce oxidative stress,and keep the balance of nutritional status of MHD patients.Using superior dialyser and high quality dialysate,avoiding contamination during dialysate can reduce the risk of dialysis-related amyloid(DRA).更多还原