中国血液净化

中国血液净化 ›› 2019, Vol. 18 ›› Issue (07): 486-490.doi: :10.3969/j.issn.1671-4091.2019.07.006

• 临床研究 • 上一篇    下一篇

高通量血液透析与常规血液透析联合血液透析滤过的临床疗效对比研究

汤晓静1,陈楠2,戎殳3,陈晓农2,倪兆慧4,张伟明4,王应灯5,庄峰5,汪年松6,盛晓华6,梅长林1   

  1. 1海军军医大学长征医院肾内科
    2交通大学医学院附属瑞金医院肾内科
    3交通大学医学院附属第一人民医院肾内科
    4交通大学医学院附属仁济医院肾内科
    5交通大学医学院附属第九人民医院肾内科
    6交通大学医学院附属第六人民医院肾内科

  • 收稿日期:2019-01-21 修回日期:2019-05-18 出版日期:2019-07-12 发布日期:2019-07-12
  • 通讯作者: 梅长林 changlinmei@smmu.edu.cn
  • 基金资助:
    上海市科委产学研医合作项目(11DZl921900)

The comparison of clinical effects and outcome in patients with high-flux hemodialysis and those with low- flux hemodialysis combined with hemodiafiltration#br#

  1. 1Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China; 2Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; 3Department of Nephrology, First People's Hospital, Jiaotong University School of Medicine, Shanghai 200080, China; 4Department of Nephrology, Renji Hospital, Jiaotong University School of Medicine, Shanghai 200120, China; 5Department of Nephrology, Shanghai Ninth People's Hospital, Jiao Tong University School of Medicine, Shanghai 200011, China;6Department
    of Nephrology, Shanghai Sixth People's Hospital, Jiaotong University School of Medicine, Shanghai 200233, China
  • Received:2019-01-21 Revised:2019-05-18 Online:2019-07-12 Published:2019-07-12

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摘要：

【摘要】目的比较高通量血液透析(high-flux hemodialysis，HFHD)与常规低通量血液透析(lowflux hemodialysis，LFHD)联合血液透析滤过(hemodiafiltration，HDF)对维持性血液透析患者治疗的 有效性和安全性。方法选取维持性血液透析患者315 例，随机分为试验组(HFHD，3 次/周)与对照组 (LFHD 2 次/周+HDF 1 次/周)，随访24 个月。结果①试验组和对照组的死亡率分别为5.66%和9.55% (χ2=1.701，P=0.191)，住院率分别为27.04%和25.48%(χ2=0.100，P=0.752)，均无显著差异。②试验组和 治疗组治疗后单室尿素清除指数(1.70 ± 1.03 比1.37 ± 0.24,t=1.782，P =0.079)、尿素下降率 (75.08%±13.15% 比70.31%±10.69%, t=1.760，P=0.082)无显著差异。试验组血清β2微球蛋白降低 [(21.52±9.94)mg/L 比(27.28±16.51)mg/L, t=-2.148，P=0.034]，说明试验组对中分子毒素的清除优于对照组。③2 组均未发生透析器相关急性并发症和透析器相关不良事件。结论2 种透析方式总体有效性和安全性相当。HFHD 对中大分子毒素的清除更好，值得推广应用。

关键词: 血液透析, 血液透析滤过, 高通量血液透析

Abstract:

【Abstract】Objective To compare the efficiency and safety of high-flux hemodialysis (HFHD) and lowflux hemodialysis (LFHD) combined with hemodiafiltration (HDF) in maintenance hemodialysis (MHD) patients. Methods A total of 315 MHD patients were recruited and divided into trial group (HFHD, 3 times per week) and control group (LFHD 2 times per week and HDF once a week). They were followed up for 24 months. Results ①There were no significant differences in mortality rate (5.66% vs. 9.55%, χ2=1.701, P=0.191) and hospitalization rate (27.04% vs. 25.48%, χ2=0.100, P=0.752) between the trial group and the control group. ②The after dialysis single pool Kt/V values in the trial and control group were 1.70±1.03 and1.37±0.24 respectively (t=1.782, P=0.079), while urea reduction rates in the two groups were 75.08±13.15% and 70.31±10.69% respectively (t=1.760, P=0.082). After the treatment, serum β2 microglobulin in the trial group was significantly lower than that in the control group (21.52±9.94mg/L vs. 27.28±16.51mg/L, t=-2.148, P=0.034). ③ No dialyzer- related acute complications and dialyzer- related adverse events occurred in both groups. Conclusion The two hemodialysis methods were equally effective and safe. HFHD had a better clearance of medium macromolecular toxins and is recommended to be used clinically.

Key words: Hemodialysis, Hemodiafiltration, High-flux hemodialysis

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