中国血液净化

中国血液净化 ›› 2026, Vol. 25 ›› Issue (01): 11-15.doi: 10.3969/j.issn.1671-4091.2026.01.003

• 临床研究 • 上一篇    下一篇

前/后稀释血液透析滤过与中截留膜透析尿毒症毒素清除的比较

徐卓佳    程 丹    王栋栋   

  1. 100123 北京，1民航总医院肾内科/透析中心
  • 收稿日期:2025-05-09 修回日期:2025-10-30 出版日期:2026-01-12 发布日期:2025-12-31
  • 通讯作者: 徐卓佳 E-mail:xuzhuojia1980@163.com

Comparison of pre-/post-hemodiafiltration and medium cut-off hemodialysis in clearance of uremic toxins

XU Zhuo-jia, CHENG Dan, WANG Dong-dong   

  1. Nephrology&Dialysis Center, Civil Aviation General Hospital, Beijing 100123, China
  • Received:2025-05-09 Revised:2025-10-30 Online:2026-01-12 Published:2025-12-31
  • Contact: 100123 北京，1民航总医院肾内科/透析中心 E-mail:xuzhuojia1980@163.com

摘要： 目的 比较前/后稀释血液透析滤过(Pre-/Post-hemodiafiltration，Pre-/Post-HDF)与中截留膜透析(medium cut-off hemodialysis，MCO-HD)对小分子、中分子和较大中分子毒素的清除情况。 方法 选取2024年3月—10月在民航总医院血液透析中心维持性血液透析的患者为研究对象，给予Pre-HDF、Post-HDF及MCO-HD治疗。比较3种治疗方式血清尿素下降率(urea reduction rate，URR)、β2-微球蛋白(β2-mocroglobuine，β2-MG)、α1-微球蛋白(α1-mocroglobuine，α1-MG)下降率，比较透析废液中β2-MG、α1-MG和白蛋白(album，ALB)的总清除量。 结果 共纳入22例患者，3种治疗方式URR比较：MCO-HD组高于Pre-HDF组(q=13.151，P＜0.001)和Post-HDF组(q=19.063，P＜0.001)。Post-HDF组β2-MG下降率高于MCO-HD组(q=4.753，P=0.005)和Pre-HDF组(q=11.022，P＜0.001)。MCO-HD组α1-MG下降率高于Pre-HDF组(q=11.647，P＜0.001)和Post-HDF组(q=7.642，P＜0.001)。透析废液中β2-MG的总去除量比较：Pre-HDF组低于Post-HDF组(q=5.691，P=0.002)和MCO-HD组(q=7.058，P＜0.001)，Post-HDF组和MCO-HD组间比较无统计学差异(q=3.252，P=0.083)。透析废液中α1-MG的总去除量比较：MCO-HD组高于Pre-HDF组(q=22.218，P＜0.001)和Post-HDF组(q=12.286，P＜0.001)。透析废液中ALB的总去除量比较：MCO-HD组高于Pre-HDF组(q=10.831，P＜0.001)和Post-HDF组(q=5.345，P=0.004)。 结论 MCO-HD与Pre-/Post-HDF相比，在去除较大中分子物质方面更有优势，但与Pre-/Post-HDF相比，MCO-HD模式下的ALB损失更明显。

关键词: 前稀释-血液透析滤过, 后稀释-血液透析滤过, 中截留透析

Abstract: Objective  To compare the clearance of small, medium, and larger medium-sized molecular toxins in patients undergoing pre-dilution/post-dilution hemodiafiltration (Pre-/Post-HDF) versus medium cut-off hemodialysis (MCO-HD). Methods 22 hemodialysis patients were treated with Pre-HDF, Post-HDF and MCO-HD respectively. The urea reduction rate (URR), as well as the serum reduction rates (RR) of β2-microglobulin (β2-MG) and α1-microglobulin (α1-MG), were compared among the three modalities. Additionally, the total clearance of β2-MG, α1-MG, and albumin (ALB) in the collected dialysate was evaluated. Results The URR in the MCO-HD group was significantly higher than that in the Pre-HDF group (q=13.151, P＜0.001) and Post-HDF group (q=19.063, P＜0.001). The reduction rate of β2-MG was higher in the Post-HDF group than that in the MCO-HD group (q=4.753, P=0.005) and the Pre-HDF group (q=11.022, P＜0.001). Conversely, the reduction rate of α1-MG was significantly higher in the MCO-HD group than that in the Pre-HDF group (q=11.647, P＜0.001) and the Post-HDF group (q=7.642, P＜0.001). Regarding total removal in dialysate, the Pre HDF group showed significantly lower β2-MG clearance than the Post-HDF group (q=5.691, P=0.002) and the MCO-HD group (q =7.058, P＜0.001), whereas no significant difference was observed between the Post-HDF group and MCO-HD group (q=3.252, P=0.083). For α1-MG, total removal was significantly higher in the MCO-HD group than that in the Pre-HDF group (q=22.218, P＜0.001) and Post-HDF group (q=12.286, P＜0.001). Similarly, ALB loss in dialysate was significantly greater in the MCO HD group than in the Pre HDF (q=10.831, P＜0.001) and Post-HDF groups (q = 5.345, P=0.004).  Conclusion  Compared with Pre/Post HDF, MCO HD demonstrates superior clearance of larger medium sized molecules but is associated with more pronounced albumin loss.

Key words: Pre-hemodiafiltration, Post-hemodiafiltration, Medium cut-off hemodialysis

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