摘要
目的 探究人工法off-line HDF对维持性血液透析(MHD)患者透析充分性、高同型半胱氨酸血症(HHcy)的影响.方法 随机选取2021至2023年于南昌大学第一附属高新医院血液透析中心稳定透析6个月以上的MHD患者30例,进行单中心自身对照研究,时长6个月.前3个月维持每周2次高通量血液透析(HFHD)联合1次on-line HDF,后3个月维持每周2次人工法off-line HDF联合1次on-line HDF.于研究第3个月、第6个月时用全自动生化分析仪检测透析前后血尿素氮(BUN)、血肌酐(SCr)、β2-微球蛋白(β2MG)、同型半胱氨酸(Hcy)、白蛋白(Alb)、C反应蛋白(CRP)、血红蛋白(Hb)、甲状旁腺素(iPTH)、磷(P)、钾(K)水平;计算血清尿素清除指数(Kt/V)、尿素下降率(URR)和β2MG清除率.结果 人工法off-line HDF模式透析的Kt/V、URR及β2MG清除率均较显著高于HFHD模式透析(P＜0.05);人工法off-line HDF模式透析Kt/V、URR及β2MG清除率达到透析充分的百分率分别为83.33%、83.33%和93.33%,均显著高于HFHD模式透析(P＜0.05).与HFHD模式透析时相比,人工法off-line HDF模式透析结束后,患者透析前Hcy水平降低,Alb水平升高(P＜0.05).结论 人工法off-line HDF模式透析可显著增加Kt/V、URR和β2MG清除率,提高MHD患者的透析充分性达标率,且对HHcy具有改善作用.
Abstract
Objective To explore the effects of artificial off-line HDF on dialysis adequacy and hyperhomocysteinemia(HHcy)in maintenance hemodialysis(MHD)patients.Methods 30 MHD patients with maintained dialysis for more than 6 months in the Hemodialysis Center of Gaoxin Hospital of the First Affiliated Hospital of Nanchang University were randomly selected for the single-center,self-controlled study.In the first 3 months,high flux hemodialysis(HFHD)was maintained twice a week in combination with 1 on-line HDF;in the second 3 months,manual off-line HDF was maintained twice a week in combination with 1 on-line HDF.Blood urea nitrogen(BUN),blood creatinine(SCr),β2-microglobulin(β2MG),homocysteine(Hcy),albumin(Alb),C-reactive protein(CRP),hemoglobin(Hb),parathyroid hormone(iPTH),phosphorus(P),and potassium(K)levels before and after dialysis were measured with an automated biochemistry analyzer at the 3rd and 6th months of the study;the serum urea clearance index(Kt/V),urea reduction rate(URR),and β2MG clearance were calculated.Results The Kt/V,URR and β2MG clearance in manual off-line HDF was significantly higher than that in HFHD(P＜0.05);the percentages of Kt/V,URR and β2MG clearance in manual off-line HDF were 83.33%,83.33%and 93.33%in dialysis adequacy,respectively,all significantly higher than those in HFHD(P＜0.05).The pre-dialytic blood Hcy level was significantly lower after manual off-line HDF than after HFHD,while the pre-dialytic Alb level was higher(P＜0.05).Conclusions Manual off-line HDF can significantly promote Kt/V,URR and β2MG clearance,increase the dialysis adequacy standard rate,and improve HHcy in MHD patients.
维普
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