【摘要】 目的探讨长期间歇性高效on-line血液透析滤过(HDF)对维持性血液透析(MHD)患者营养状况的影响。方法回顾性分析2004年1月至2011年2月楚雄彝族自治州人民医院肾脏内科血液净化中心收治的透析龄超过5年、资料完整的112例MHD患者的治疗资料,按不同透析方式将患者分为长期间歇性高效HDF组(60例)和常规血液透析(HD)组(52例),评估长期间歇性高效HDF对MHD患者营养状况的影响,并对影响主观综合营养评估(SGA)的因素进行分析。结果治疗12、36、60个月后,长期间歇性高效HDF组患者清蛋白(ALB)水平和SGA评分均明显优于同期常规HD组,差异均有统计学意义(P<0.05)。尿素清除指数(Kt/V)、β2微球蛋白(β2-MG)、C反应蛋白(CRP)、ALB、碳酸氢盐(HCO3-)是影响长期MHD患者SGA的独立因素,其中Kt/V、ALB和HCO3-为正性影响因子,β2-MG、CRP为负性影响因子。结论长期间歇性高效on-line HDF治疗通过进一步提高充分透析性、更好地纠正酸中毒和减轻体内炎症状态,以及维持较高的血清ALB水平,可持续显著改善MHD患者的营养状况,且效果优于单纯HD治疗。更多还原

【Abstract】 Objective To investigate the influence of long-term intermittent high-efficiency on-line hemodiafiltration（HDF）on the nutritional status in maintenance hemodialysis（MHD） patients.Methods One hundred and twelve patients with MHD,over 5 years dialysis history and intact data at the blood purification center of the nephrology department in Chuxiong Yi Au-tonomous Prefecture People′s Hospital from January 2004 to February 2011 were selected for conducting the retrospective analy-sis.The patients were divided into the intermittent high-efficiency HDF group（n=60） and conventional hemodialysis group（HD,n=52） based on the hemodialysis mode.Then the influence of long-term intermittent high-efficiency HDF on the nutritional status in MHD patients was evaluated,and the factors affecting the subjective global assessment（SGA） were analyzed.Results After 12,36,60 months of treatment,the scores of ALB and SGA in the long term intermittent high-efficient HDF group were better than those in the conventional HD group at the same period（P<0.05）.Kt/V,β₂-MG,CRP,ALB and HCO₃^- were the independent factors affecting SGA in MHD patients.Among them,Kt/V,ALB and HCO₃^- were the positive influencing factors,while β₂-MG and CRP were the negative influence factors.Conclusion Long-term intermittent high-efficiency on-line HDF can continuously and significantly improve the nutritional status in MHD patients by further increasing hemodialysis adequacy,better correcting acidosis,reducing in vivo inflammation status and maintaining a higher level of serum albumin,moreover its effect is superior to that of simple HD therapy.更多还原