不同血液净化方法对慢性肾衰竭患者血清中分子毒素清除的比较

李明旭; 吕鹏; 雷霞; 李洪艳

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中国血液净化 ›› 2005, Vol. 4 ›› Issue (12) : 652-654.

论著

不同血液净化方法对慢性肾衰竭患者血清中分子毒素清除的比较

李明旭1 吕鹏2 雷霞1 李洪艳1

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摘要

目的比较不同血液净化方法对慢性肾衰竭维持性血液透析患者血清中分子毒素的清除。方法慢性肾衰竭维持性血液透析患者36例，随机分为3组：HP+HD组，接受树脂吸附联合血液透析治疗；HDF组，接受血液透析滤过治疗；HD组，接受血液透析治疗；治疗前后测定血清PTH、视黄醇结合蛋白等，观察8周治疗后，3组患者皮肤搔痒、骨关节疼痛症状改善程度。结果 HP+HD组治疗后血清PTH从 (185.59±63.25)μg/L降至 (109.72±50.11)μg/L，治疗前后比较差异具有显著性 (P ＜0.01)；视黄醇结合蛋白从 (96.67± 38.16) mg/L降至(63.34±31.38)mg/L，治疗前后比较差异有显著性 (P＜0.05)。HDF组治疗后PTH从(178.89±64.93)μg/L降至(125.48±61.24)μg/L，治疗前后比较差异有显著性(P＜0.05)。而视黄醇结合蛋白从(88.59±34.93)mg/L降至(71.48±36.24)mg/L，治疗前后比较差异无显著性 (P＞0.05)。HD组患者治疗后血清PTH从 (186.08±52.09) μg/L 降至(169.60±71.24)μg/L，视黄醇结合蛋白为(89.08±42.49)mg/L及(89.66±38.04) mg/L，治疗前后差异无显著性 (P＞0.05)。4周治疗后，HP+HD组原有皮肤瘙痒或骨关节疼痛7例患者，症状均明显改善；HDF组血液透析滤过组6例有3例症状改善，HD组8例无1例改善。结论 ①树脂吸附能有效清除血清iPTH及视黄醇结合蛋白；对皮肤瘙痒或骨关节疼痛症状均有明显改善；②血液透析滤过对分子质量相对较小的iPTH有一定的清除效果，对分子量较大的视黄醇结合蛋白清除效果不显著；对皮肤瘙痒或骨关节疼痛症状均有一定的改善作用；③血液透析对血清PTH及视黄醇结合蛋白无清除作用。

Abstract

Objective Compared the clearance for serum middle molecule substances with different blood purification methods in chronic renal failure Methods The 36 cases were divided into 3 groups by freedom: HD+HP group(11 cases), HDF group (13 cases), HD group (12 cases). Before and after treatment, the serum iPTH and sRBP was measured. Results After treatment, the serum iPTH was obviously decreased from (185.59±63.25)ug/L to (109.72±50.11)ug/L (P＜0.01)、sRBP was from (96.67±38.16)mg/L to (63.34± 31.38)mg/L(P＜0.05) in HD+HP group；The serum PTH was obviously decreased from (178.89±64.93)ug/L to (125.48±61.24)(P ＜0.05)、the sRBP was decreased from (88.59±34.93)mg/L to (71.48±36.24)mg/L(P＞0.05) in HDF group；the serum PTH was from (186.08±52.09)ug/L to (169.60±71.24)ug/L(P＞0.05)、sRBP was from (89.08±42.49)mg/L;(89.66±38.04)mg/L(P＞0.05)in HD group. Conclusion Colophony absorption can effectively clean out serum PTH and sRBP. It can obviously improve the skin pruritus and bone-arthrosis pain. HDF can effectively clean out serum iPTH and improve the skin pruritus and bone-arthrosis pain too. But the HD has no this effect.