中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (08): 523-528.doi: 10.3969/j.issn.1671-4091.2018.08.005

• 临床研究 • 上一篇    下一篇

三醋酸纤维素膜与聚砜膜透析器在维持性血液透析患者的临床对照研究

云扬1,张晨2,刘乃全2,周光宇2,李德天2   

  1. 1. 中国医科大学附属盛京医院血液净化中心
    2. 中国医科大学附属盛京医院肾脏内科
  • 收稿日期:2018-04-27 修回日期:2018-05-16 出版日期:2018-08-12 发布日期:2018-08-12
  • 通讯作者: 李德天 lidetian126@163.com E-mail:lidetian126@163.com

A control study on the dialyzers with cellulose triacetate membrane and with polysulfone membrane for maintenance hemodialysis patients

  • Received:2018-04-27 Revised:2018-05-16 Online:2018-08-12 Published:2018-08-12

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摘要： 【摘要】背景随着透析器膜材料的不断发展和优化，聚砜膜(polysulfone,PS)作为第三代透析膜，因其更好的生物相容性，已经取代醋酸纤维素膜，并在市场上占据主导地位。但是我们在临床工作中发现，对PS 过敏的患者，应用三醋酸纤维膜(cellulose triacetate,CTA)后，患者的过敏症状得到缓解。目的本文旨在比较CTA 和PS 透析器对维持性血液透析(maintenance hemodialysis,MHD)患者毒素清除、对血液系统的影响以及生物相容性的差异。方法选取2017 年6～9 月中国医科大学附属盛京医院第二血液净化中心MHD 患者60 例。随机分为CTA 组和PS 组，每组30 例。每周3 次血液透析，每次4h，治疗2 个月。比较CTA 和PS 透析器对尿素氮(blood urea nitrogen，BUN)，肌酐(creatinine,CR)，血磷(serum phosphorus,P) 的清除情况；对血红蛋白(Hemoglobin,Hb)，血小板(platelet,PLT)，白细胞(white blood cell,WBC)影响；以及C-反应蛋白(c-reactive protein,CRP)，IgE，补体C3(complement 3,C3)，血管细胞粘附分子-1(vascular cell adhesion molecule-1, VCAM-1)，细胞间黏附分子-1(intercellular adhesion molecule- 1, ICAM- 1)等指标的差异。结果 2 组患者在年龄(t=- 0.735, P=0.465)、性别(χ2= 2.410, P=0.120)、透析龄(t=0.336，P=0.738)和原发病(χ2=3.817，P=0.701)等方面基本一致，组间比较无统计学差异。应用CTA 及PS 透析器治疗前，所有数据组间比较均无统计学意义，基线数据均衡。应用CTA 及PS 透析器规律血液透析治疗2 个月后：①2 组CR, BUN 和P 组间比较无统计学差异(P值分别为0.483，0.605，0.734)。2 组透析前后上述指标的变化组间比较无统计学差异(P 值分别为0.808，0.343，0.319)。②CTA 组透析前后Hb 的变化较PS 组具有统计学差异(t=-2.282，P=0.027)，CTA 组贫血改善优于PS 组。③PS 组PLT 较CTA 组有明显差异(t=2.947，P =0.005)；PS 组透析前后PLT 的变化较CTA 组具有统计学差异(t=2.219，P =0.031)；CTA 组对PLT 的影响小于PS 组。④2 组WBC，VCAM-1，ICAM-1,IgE，CRP 和C3 组间比较无统计学差异(P 值分别为0886，0.187，0.475, 0.317, 0.886, 0.226)；两组透析前后上述指标的变化，上述指标的变化组间比较无统计学差异(P 值分别为0.056，0.053，0.934，0.230，0.460，0.075)。结论① CTA 与PS 透析器对CR，BUN 及P 等小分子毒素清除能力无明显差异。②CTA 透析器对贫血的改善优于PS 透析器；③CTA 透析器对PLT 的影响优于PS 透析器。④CTA 透析器对炎症，过敏，补体系统的影响与PS透析器比较无差异，两者具有相似的生物相容性。

关键词: 血液透析, 三醋酸纤维膜, 聚砜膜, 生物相容性, 血红蛋白, 血小板

Abstract: 【Abstract】Background With the continuous development and optimization of dialysis membrane materials, polysulfone (PS) as the third generation of dialysis membrane has replaced cellulose triacetate (CTA) and dominated the market because of its better biocompatibility. However, we found that the hypersensitivity to PS could be remitted by the application of CTA in clinical practice. Objective To compare the differences in toxin removal, hematological change and biocompatibility in maintenance hemodialysis (MHD) patients using CTA dialyzer and PS dialyzer. Methods A total of 60 MHD patients treated in the Second Blood Purification Center, Shengjing Hospital, Chinese Medical University from June 2017 to September 2017 were enrolled in this study. They were randomly divided into group CTA and group PS (n=30/each group). They were treated with regular hemodialysis of 4 hours/time and 3 times/week for 2 months. The clearances of creatinine (CR), blood urea nitrogen (BUN) and serum phosphorus (P), the changes of hemoglobin (Hb), platelet (PLT)and white blood cell (WBC), and the differences of C-reactive protein (CRP), IgE, complement 3 (C3), vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) were compared between group CTA and group PS. Results Age (t=-0.735, P=0.465), gender (c2=2.410, P=0.120), dialysis age (t=0.336, P=0.738) and primary diseases (c2=3.817, P=0.701) had no statistical differences between the two groups. Before the hemodialysis with CTA dialyzer and PS dialyzer, there were no statistical differences in all of the parameters between the two groups (P＞0.05). After application of CTA dialyzer and PS dialyzer for 2 months, ①there were no statistical differences in CR, BUN and P, nor in the changes of the above indicators between the two groups (P＞0.05); ② there was a statistical difference in Hb change between the two groups (t=-2.282, P=0.027), with better improvement of anemia in group CTA; ③ there was a statistical difference in PLT (t=2.947, P=0.005) between the two groups, with slighter change in group CTA than in group PS (t=2.219, P=0.031); and ④there were no statistical significances in WBC, VCAM-1, ICAM-1, IgE, CRP and C3 between the two groups (P＞0.05). Conclusion ①There were no significant difference in the clearances of small molecule toxins such as CR, BUN and P between CTA dialyzer and PS dialyzer. ② CTA was better than PS in the improvement of anemia. ③ The effect on PLT was less in group CTA than in group PS. ④ There were no differences in inflammation and allergy factors, complement system, and biocompatibility in MHD patients using CTA dialyzer and PS dialyzer.

Key words: Hemodialysis, Cellulose triacetate, Polysulfone, Biocompatibility, Hemoglobin, Platelet