【摘要】 目的探讨血液透析(HD)、血液灌流+血液透析(HP+HD)、血液透析滤过(HDF)三种透析方式清除中分子毒素甲状旁腺激素(PTH)、β2微球蛋白(β2-MG)的效果,对超敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)水平的影响,并观察对患者的生活质量的影响。方法按随机数字表选取134例患者随机分为单纯血液透析组(A组,47例)、血液灌流+血液透析组(B组,43例)、血液透析滤过组(C组,44例),检测不同时间甲状旁腺激素(PTH)及β2微球蛋白(β2-MG)、超敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)水平。随访观察24个月,采用KDQOL-SFTM1.3量表评价比较三组患者生活质量的评分。结果随访观察24个月,A、B、C组分别死亡15、5、7例,失访3、2、2例。观察到12个月、18个月、24个月时,B、C组PTH、β2-MG水平均低于A组(P<0.01),6个月、12个月、18个月、24个月时hs-CRP、IL-6水平均低于A组(P<0.01),B组β2-MG水平高于C组(P<0.01),B、C组间PTH值差异无统计学意义(P>0.05)。B、C组间hs-CRP、IL-6值差异无统计学意义(P>0.05)。观察期结束时,B组、C组患者的肾脏病与透析相关生存质量(KDTA)和一般健康相关生存质量(SF-36)评分高于A组,Kaplan-Meier生存曲线显示B组、C组患者具有生存优势(P<0.05),B、C组间生存率比较差异无统计学意义(P>0.05)。结论 1.血液透析滤过、血液灌流+血液透析较血液透析更能有效的清除MHD患者体内PTH和β2-MG以及微炎症因子包括超敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)。2.血液透析滤过、血液灌流+血液透析较血液透析能更好的改善患者的生存质量,提高患者生存率。更多还原

【Abstract】 Objective To compare the effects of different blood purification methods( hemodialysis,hemodialysis plus hemodiafiltration, hemodiafiltration) on clearance of parathyroid hormone, beta 2-microglobulin,hs-CRP and IL-6 and the quality of life among maintenance hemodialysis patients,and study effective interventions to improve quality of life. Methods A prospective randomized clinical study was carried out.One hundred and thirty-four MHD patients were enrolled and randomly divided into three groups( group A hemodialysis 47 cases,group B hemodialysis plus hemodiafiltration 43 cases,and group C hemodiafiltration 44 cases). Serum parathyroid hormone,beta 2-microglobulin,hs-CRP and IL-6 levels were examined in different periods. After 24 months of follow-up,KDQOL-SFTM1.3 scale was used to evaluate the score of quality of life in the three groups.Results After follow up for 24 month,15,5,7 cases died and 3,2,2 cases lost in groups A,B,C respectively. Observed at 12 month,18 month and 24 month,the levels of PTH,beta 2-MG in groups B and C were lower than those in group A( P<0.01). Observed at 6 months,12 month,18 month and 24 month,the levels of hs-CRP and IL-6 in groups B and C were lower than those in group A( P < 0. 01),and beta 2-MG level in group B was higher than that in group C( P< 0. 01); meanwhile there were no significant differences of PTH,hs-CRP and IL-6 levels between group B and C( P>0.05). At the end of the observation period,the scores of KDTAand SF-36 in groups B and C were significant higher than those in group A. Kaplan-Meier survival curves showed that patients in groups B and C had survival advantage( P<0.05),there was no significant difference in the survival rate of group B and C( P>0.05).Conclusions Hemodiafiltration or hemoperfusion plus hemodialysis is more effective to remove the PTH and beta 2-MG and microinflammatory factors including hs-CRP and IL-6.Hemodiafiltration or hemoperfusion plus hemodialysis can improve the quality of life of patients and improve the survival rate.更多还原