中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (07): 379-383.doi: 10.3969/j.issn.1671-4091.2013.07.00

• 临床研究 • 上一篇    下一篇

不同透析膜对维持性血液透析患者骨矿物质代谢及微炎症状态的影响

肖白丽1,2,隋小妮1,张云静3,李红梅1,邹作君4   

  1. 1. 青岛市立医院
    2. 潍坊医学院
    3. 兖矿集团医院
    4. 青岛市市立医院
  • 收稿日期:2012-12-03 修回日期:2013-04-16 出版日期:2013-07-12 发布日期:2013-07-06
  • 通讯作者: 邹作君 E-mail:zzj@medmail.com.cn

Effect of different dialysis membrane on mineral metabolism and micro-inflammatory status of maintenance hemodialysis patients

  • Received:2012-12-03 Revised:2013-04-16 Online:2013-07-12 Published:2013-07-06

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摘要： 目的 比较不同透析膜和不同膜面积的透析器对维持性血液透析（MHD）患者骨矿物质代谢及微炎症状态的影响。 方法 选择MHD患者40例，随机分为3组：FX组16例（使用德国Fresenius公司FX60型高通量透析器，膜面积1.3 m2）、TS组14例（使用日本Toray公司TS-1.3S型高通量透析器，膜面积1.3 m2）、CA组10例(使用美国Baxter公司CA-HP-170型低通量透析器，膜面积1.7 m2)，全部患者每周透析3次，每次4小时。比较入组前和治疗3个月、6个月后血清尿素氮(BUN)、肌酐(Cr)、尿酸（Ua）、白蛋白（ALB）、钙(Ca)、磷(P)、甲状旁腺激素（iPTH）、β2微球蛋白(β2-MG)、超敏C反应蛋白（Hs-CRP）、白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、丙二醛（MDA）和超氧化物歧化酶(SOD)浓度变化。 结果 各组患者血清BUN、Cr、Ua、P、iPTH、Hs-CRP和IL-6治疗前后无明显差异（P﹥0.05）；β2-MG在3个月时各组均明显下降（P＜0.05）并呈稳定状态；3个月时ALB各组均有上升趋势，但6个月CA组明显下降（P＜0.05）；TNF-α CA组升高，FX组和TS组下降（P＜0.05）； CA组MDA明显升高（P＜0.05），SOD虽有下降趋势，但无统计学意义（P﹥0.05）；FX组和TS组MDA明显下降（P＜0.05）,SOD 3个月即开始下降（P＜0.05），6个月与3个月时比较进一步下降（P＜0.05）。结论 （1）高通量透析器尽管膜面积较小，但对小分子毒素清除效果与大面积低通量透析器相当。（2）高通量透析可抑制氧化应激、改善微炎症状态，维持营养平衡。（3）对预防透析相关淀粉样变，除选用优质透析器外，提高透析液质量和避免各环节污染十分重要。

关键词: 血液透析, 高通量透析, β2微球蛋白, 氧化应激, 炎性因子

Abstract: Objective The aim of this study is to compare the effect of three dialyzers with different dialysis membranes and membrane area on mineral metabolism and micro-inflammation status of maintenance hemodialysis(MHD) patients. Method 40 MHD patients were recruited and randomly assigned to 3 groups: 16 patients in FX group (German Fresenius company FX60 high-flux dialyzer, membrane area of 1.3 m2), 14 patients in TS group (Japanese TORAY company TS-1.3S high-flux dialyzer, membrane area of 1.3 m2), 10 patients in CA group (United States Baxter company CA-HP-170 low-flux dialyzer, membrane area of 1.7 m2). All patients received four-hour dialysis three times per week. Serum level of urea nitrogen(BUN), creatinine(Cr), uric acid(Ua), albumin(ALB), calcium(Ca), phosphorus(P), intact PTH(iPTH), beta2-micro-globulin concentration(β2-MG), high-sensitive C-reactive protein (Hs-CRP), superoxide dismutase(SOD), interleukin-6( IL-6), malondialdehyde (MDA), tumor necrosis factor-α（TNF-α）， at baseline and the end of 3rd and 6th month were compared. Results There is no significant change in serum levels of BUN, Cr, Ua, P, iPTH, Hs-CRP and IL-6 from baseline to the end of 3rd and 6th month(P＞0.05). In all groups serum levels of β2-MG decreased significantly at the end of 3rd month and kept stable(P＜0.05). In all groups serum levels of ALB increased at the 3rd, but in CA group it decreased significantly at 6rd(P＜0.05). Serum level of TNF-α increased in CA group while decreased in FX group and TS group(P＜0.05). In CA group serum level of MDA increased significantly(P＜0.05), level of SOD decreased insignificantly. In FX group and TS group serum levels of MDA decreased significantly(P＜0.05)，serum levels of SOD decreased significantly at 3th month(P＜0.05), and they both further decreased significantly from the 3rd to the 6th month(P＜0.05). Conclusion (1)Small-area high-flux dialysis is comparable with low-flux hemodialysis on the removing of small molecular uremic toxins. (2)High-flux dialysis may improve micro-inflammation state, reduce oxidative stress, and keep the balance of nutritional status of MHD patients. (3)Using superior dialyser and high quality dialysate, avoiding contamination during dialysate can reduce the risk of dialysis-related amyloid(DRA).

Key words: Hemodialysis, High-flux dialysis, Beta 2-micro-globulin, Oxidative stress, Inflammatory factor