中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (11): 914-918.doi: 10.3969/j.issn.1671-4091.2025.11.008

• 临床研究 • 上一篇    下一篇

不同血液净化模式对患者血清β2-微球蛋白、血脂、血管钙化的影响

李智全    梁 娟   武 欣   

  1. 457000 濮阳，河南省濮阳市人民医院1血液病研究所 2儿科二病区
  • 收稿日期:2024-12-10 修回日期:2025-08-21 出版日期:2025-11-12 发布日期:2025-11-12
  • 通讯作者: 李智全 E-mail:shazha51977@163.com
  • 基金资助:
    河南省医学科技攻关计划联合共建项目和软科学项目

Effects of different blood purification modalities on serum β2-microglobulin, lipid profile, and vascular calcification

LI Zhi-quan, LIANG Juan, WU Xin   

  1. Institute of Hematology and 2Second Department of Pediatrics, Puyang People's Hospital, Puyang 457000, China
  • Received:2024-12-10 Revised:2025-08-21 Online:2025-11-12 Published:2025-11-12
  • Contact: 457000 濮阳，河南省濮阳市人民医院1血液病研究所 E-mail:shazha51977@163.com

摘要： 目的 探讨不同血液净化模式对维持性血液透析(maintenance hemodialysis,MHD)患者β2-微球蛋白水平、血脂及血管钙化的影响。 方法 回顾性分析濮阳市人民医院2019年1月─2022年12月收治的174例MHD患者临床资料，根据不同血液净化模式将患者分为单纯血液透析(hemodialysis，HD)组，HD联合血液透析滤过(hemodiafiltration，HDF)组(HD+HDF组)，HD+HDF联合血液灌流hemoperfusion，HP)组(HD+HDF+HP组)，每组58例。比较3组β2-微球蛋白、血脂及血管钙化水平，采用Logistic回归分析血管钙化危险因素。 结果 透析后，HD组患者血磷、全段甲状旁腺激素(intact parathyroid hormone，iPTH)、β2-微球蛋白(β2-microglobulin，β2-MG)、总胆固醇(total cholesterol，TC)、三酰甘油(triglycerides，TG)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol，LDL-C)均高于HD+HDF组及HD+HDF+HP组(F/χ2=12.753、12.552、6.524、5.873、10.908、17.272，均P＜0.001)，高密度脂蛋白胆固醇(high-density lipoprotein cholesterol，HDL-C)低于HD+HDF组及HD+HDF+HP组(F=17.148，P＜0.001)。HD组血磷、iPTH、β2-MG、TC、TG、LDL-C 均高于HD+HDF组(t=12.963、13.630、5.648、5.242、11.044、18.632，均P＜0.001)，HDL-C低于HD+HDF(t=17.031，P＜0.001)。HD组血磷、iPTH、β2-MG、TC、TG、LDL-C均高于HD+HDF+HP组(t=13.921、14.567、6.853、6.320、9.282、16.041，均P＜0.001)，HDL-C低于HD+HDF+HP组(t=18.242，P＜0.001)。HD组血管钙化率高于HD+HDF+HP组(t=5.570，P＜0.001)。血管钙化组年龄、透析龄、血钙、血磷、iPTH、TC、LDL-C、β2-MG均高于非钙化组(t=8.630、6.205、6.073、4.598、4.617、3.562、4.648、5.673，均P＜0.001)。Logistic回归显示，年龄、透析龄、血钙、血磷、iPTH、β2-MG是血管钙化的独立危险因素(OR=1.123、1.087、4.582、3.874、2.034、2.402，95% CI 1.034～1.346、0.012～1.298、1.452～15.224、1.376～13.302、1.173～8.375、1.256～11.408，P=0.004、＜0.001、＜0.001、＜0.001、＜0.001、＜0.001)。 结论 MHD患者血管钙化的发生与多种因素有关，临床需要加强监测并给予及时干预，降低血管钙化的风险。

关键词: 维持性血液透析, 透析模式, β2-微球蛋白水平, 血脂, 血管钙化

Abstract: Objective To investigate the impact of different blood purification modalities on serum β2-microglobulin (β2-MG) level, lipid profile, and vascular calcification in patients undergoing maintenance hemodialysis (MHD).  Method  A retrospective analysis was conducted on clinical data of the 174 patients admitted to Puyang People’s Hospital between January 2019 and December 2022 for MHD. According to the blood purification modality they used, the patients were divided into three groups: conventional hemodialysis (HD) group (n=58), hemodialysis combined with hemodiafiltration (HD+HDF) group (n=58), and hemodialysis plus hemodiafiltration and hemoperfusion (HD+HDF+HP) group (n=58). Serum β2-microglobulin, lipid profile, and the extent of vascular calcification were compared among the three groups. Logistic regression was employed to identify risk factors for vascular calcification.  Result  After dialysis, blood phosphorus, intact parathyroid hormone (iPTH), β2-MG, total cholesterol (TC), triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) in HD group were higher than those in HD+HDF group and HD+HDF+HP group (F/χ²=12.753, 12.552, 6.524, 5.873, 10.908 and 17.272 respectively; P＜0.001), while high-density lipoprotein cholesterol (HDL-C) in HD group was lower than that in HD+HDF group and HD+HDF+HP group (F=17.148，P＜0.001). Blood phosphorus iPTH, β2-MG, TC, TG and LDL-C in HG group were higher than those in HD+HDF group (t=12.963, 13.630, 5.648, 5.242, 11.044 and 18.632 respectively; P＜0.001), while HDL-C in HD group was lower than that in HD+HDF group (t=17.031, P＜0.001). Blood phosphorus iPTH, β2-MG, TC, TG, LDL-C in HG group were higher than those in HD+HDF+HP group (t=13.921, 14.567, 6.853, 6.320, 9.282 and 16.041 respectively; P＜0.001), while HDL-C in HD group was lower than that in HD+HDF+HP group (t=18.242, P＜0.001). Vascular calcification rate in HD group was higher than that in HD+HDF+HP group (t=5.570, P＜0.001). Age, dialysis age, blood calcium, blood phosphorus, iPTH, TC, LDL-C, and β2-MG in vascular calcification group were higher than those in non-calcification group (t=8.630, 6.205, 6.073, 4.598, 4.617, 3.562, 4.648 and 5.673 respectively; P＜0.001). Logistic regression showed that age, dialysis age, blood calcium, blood phosphorus, iPTH, and β2-MG were the independent risk factors for vascular calcification (OR=1.123, 1.087, 4.582, 3.874, 2.034 and 2.402 respectively; 95% CI:1.034～1.346, 0.012～1.298, 452～15.224, 1.376～13.302, 1.173～8.375 and 1.256～11.408 respectively; P=0.004,＜0.001,          ＜0.001, ＜0.001, ＜0.001 and ＜0.001 respectively).   Conclusion   The occurrence of vascular calcification in MHD patients is related to multiple factors. Clinical monitoring and timely intervention are needed to reduce the risk of vascular calcification.

Key words: Maintenance hemodialysis, Dialysis mode, β2-microglobulin, Lipid profile, Vascular calcification

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