中国血液净化

›› 2005, Vol. 4 ›› Issue (9): 487-490.

• 论著 • 上一篇    下一篇

高通量透析对维持性血液透析患者左心室结构与功能影响

张庆红1 张文君2 张建鄂1 吴平勇1 王顺华1 李 涛1   

  1. 44200 十堰，1. 郧阳医学院附属十堰市太和医院肾内科 2.B超室
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2005-09-12 发布日期:2005-09-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2005-09-12 Published:2005-09-12

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摘要：

目的 探讨高通量透析对维持性血液透析患者左心室结构与功能的影响情况及作用机制。 方法 55例患者随机分为高通量透析组（HPD组）与常规血液透析组（CHD组），HPD组使用聚砜膜F60高通量透析器，CHD组使用聚砜膜低通量F6透析器，检测治疗前、后血尿素氮（BUN）、肌酐（Scr）、K+、Na+、CI-、Ca2+、P3-、甲状旁腺激素（PTH）、超声心动图、血浆细胞因子（IL-1β、IL-6、IL-8、TNF-α）和透析开始20分钟后透析废液中上述细胞因子含量，动态检测透析前、后血红蛋白、红细胞压积，透析治疗1年后，复测并比较上述指标。结果 HPD组对PTH、P3-清除明显高于CHD组（P＜0.05），且对改善贫血较CHD组显著（P＜0.05）。单次透析后，HPD组和CHD组均可减轻左心室重量(LVM)、缩小左心室舒张未期容积(LVDd)，两组间无差异（P＞0.05），但透析1年后，两组间比较差异有显著（P＜0.05）。结论 透析可改善左心室的收缩及舒张功能，且HPD减轻左心室功能更明显，机制与HPD能清除一些不易被CHD清除的大中分子物质主要是PTH、细胞因子及明显改善贫血有关。

关键词: 高通量透析, 左心室结构与功能

Abstract:

Objective To study the effect of high flux dialysis on of left ventricular structure and function maintenance hemodialysis patients and its mechanism. Methods A total of 55 hemodialysis patients were divided into two groups: high flux hemodialysis (HPD) group, treated with Fresenius F60 polysulfone dialyzer; conventional hemodialysis (CHD) group, treated with Fresenius F6 polysulfone dialyzer. Before and after the treatments, blood urea nitrogen(BUN), creatinine(Cr), potassium, sodium, chloride, calcium, phosphorus, parathyroid hormone(PTH)，echocardiography and Hb, hematocrie(Hct) were measured. At the same time, the levels of serum cytokines(IL-1β, IL-6, IL-8, TNF-α)were determined by radioimmunoassay, and the levels of cytokine in dialysate were also detected. After one year, all index were remeasured. Results The clearance of serum phosphorus, PTH were significantly higher in HPD group than that in CHD group (P＜0.05). The left ventricular mass and left ventricular end diastolic volume were decreased after hemodialysis, while there were no significant difference between HPD group and CHD group. But after one year, there were significant differences between the two groups. Conclusions Hemodialysis can improve left ventricular diastolic and systolic function in patients with maintenance hemodialysis, HPD can improve them more effectively. Possible mechanism may be correlated with the clearance of midde molecular substances suchas PTH,(PTH), cytokine and improving of renal anemia.

Key words: Echocardiography, Left ventricular structure and function

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