中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (04): 175-179.doi: 10.3969/j.issn.1671-4091.2013.04.00

• 临床研究 • 上一篇    下一篇

血液透析联合血液灌流对维持性血液透析患者左心室功能的保护作用

马云伶1,杨雪莲1,唐子勇2   

  1. 1. 北京市延庆县医院肾内科
    2. 北京大学第三医院肾内科
  • 收稿日期:2012-10-17 修回日期:2013-01-31 出版日期:2013-04-12 发布日期:2013-07-01
  • 通讯作者: 唐子勇 E-mail:ziyongtang@sohu.com

Impact of hemoperfusion combined with hemodialysis on the left ventricular function in patients with maintenance hemodialysis

  • Received:2012-10-17 Revised:2013-01-31 Online:2013-04-12 Published:2013-07-01

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摘要： 【摘要】目的 在维持性血液透析(MHD)患者中，左心室功能和患者的预后明显相关。本研究欲探讨在常规血液透析的患者中，联合血液灌流是否能影响患者的左心室功能。 方法 59例MHD患者，随机分为2组，单纯血液透析组(HD，3次/周，4h/次)30人，血液透析联合血液灌流组(HP+HD，每周1次血液灌流联合血液透析+2次常规血液透析)29人，于治疗前及治疗6个月后经超声心动图测定患者左心室功能指标并计算左室质量指数(LVMI)，同时记录患者相关的临床和血液理化指标。 结果 2组患者入选时基本临床指标、血清β2微球蛋白(β2-MG)、全段甲状旁腺激素(iPTH)水平和左心室功能指标无显著差异(P ＞0.05)。治疗6个月后，HD组患者左心功能指标、血清β2MG及PTH水平与治疗前比较无明显差异(P ＞0.05)，HD+HP组患者心脏结构和功能较前改善，患者的血清β2-MG水平和LVMI较治疗前明显降低(P值分别为0.017和0.035)，2者呈明显正相关(P=0.034)。 结论 维持性血液透析患者同时联合血液灌流治疗有助于减轻其左心室结构和功能损害，其机理可能是由于一些中大分子的尿毒症毒素被清除的缘故。 目的：在维持性血液透析患者中，左心室功能和患者的预后明显相关。本研究欲探讨在常规血液透析的患者中，联合血液灌流是否能影响患者的左心室功能。 方法：59例维持性血液透析（MHD）患者，随机分为两组，单纯血液透析组（HD，3次/周，4小时/次）30人，血液透析联合血液灌流组（HP+HD，每周1次血液灌流联合血液透析+2次常规血液透析）29人，于治疗前及治疗6个月后经超声心动图测定患者左心室功能指标并计算左室质量指数（LVMI），同时记录患者相关的临床和血液理化指标。 结果： 两组患者入选时基本临床指标、血清β2微球蛋白（β2-MG）、甲状旁腺激素（PTH）水平和左心室功能指标无显著差异（P>0.05）。治疗6个月后，HD组患者左心功能指标、血清β2MG及PTH水平与治疗前比较无明显差异（P>0.05），HD+HP组患者心脏结构和功能较前改善，患者的血清β2-MG水平和LVMI较治疗前明显降低（p值分别为0.017和0.035），两者呈明显正相关（p=0.034）。 结论： 维持性血液透析患者同时联合血液灌流治疗有助于减轻其左心室结构和功能损害，其机理可能是由于一些中大分子的尿毒症毒素被清除的缘故。

关键词: 血液灌流, 血液透析, 左心室肥厚

Abstract: 【Abstract】 Objective To investigate whether the combination of maintenance hemodialysis (MHD) with hemoperfusion (HP) improves left ventricular function in MHD patients. Methods This study was a prospective, randomized, controlled clinical trial. Fifty-nine MHD patients were selected and randomly divided into two groups. Group HD was given hemodialysis (HD) 3 times a week, and group HP+HD received HD 2 times a week and HD combined with HP once a week. This study lasted for 6 months. Left ventricular structure and function of the patients were measured by echocardiography before and after the study. Clinical and laboratory data were also collected. Results Before the study, there were no differences in antihypertensive drugs, systolic blood pressure (SBP), diastolic blood pressure (DBP), serum concentrations of CRP, iPTH and β2-MG, and left ventricular mass index (LVMI) between the two groups. At the end of the six months observation, serum β2-MG and LVMI decreased significantly in group HD+HP (P =0.017 and 0.035, respectively), but showed no differences in group HD. There is a positive correlation between serum β2-MG level and LVMI in group HD+HP (P =0.034). Conclusion MHD combined with HP could reduce LVMI in MHD patients, probably due to the better clearance of middle and large molecular uremic toxins. Objective: To investigate whether the combination of maintenance hemodialysis (MHD) with hemoperfusion (HP) could improve the left ventricular function of MHD patients. Methods: This study was a prospective, randomized, controlled clinical trial. 59 MHD patients were selected and then randomly divided into two groups. Group HD was given HD alone 3 times a week, whereas Group HP+HD received HD alone 2 times a week and the combined treatment of HD with HP once a week. This study was followed up for 6 months and the patients’ left ventricular structure and function was measured by echocardiography before and after the study. The clinical and laboratory data were also collected. Results: There are no difference in the types of antihypertensive drugs, systolic blood pressure (SBP), diastolic blood pressure (DBP), serum concentration of CRP, iPTH, β2-MG, left ventricular mass index (LVMI) of the two groups before the study. At the end of the 6-months’ observation, the serum level of β2-MG and LVMI of the group HD+HP decreased significantly (P=0.017 and 0.035 respectively) while there is no difference in the group HD. There is a significant correlation between the level of β2-MG and LVMI in the HD and HP group (p=0.034)。 Conclusion: Maintenance hemodialysis combined with hemoperfusion could reduce the LVMI of MHD patients. It may be due to the clearance of middle and large molecular uremic toxins.

Key words: Hemoperfusion, hemodialysis, left ventricular hypertrophy