| 摘要: |
| 目的 探讨血液灌流(hemoperfusion,HP)的时机对血液透析(hemodialysis,HD)联合HP型组合型人工肾(combined artificial kidney,CAK)清除维持性血液透析(maintenance hemodialysis,MHD)患者尿毒症相关毒素效果的影响。方法 选取2012年7月至2013年1月于我院血透室接受HD治疗(4 h/次,3次/周)3个月以上的终末期肾病患者20例。所有患者先后接受2次不同方式的CAK治疗(A方式: HD第1、2小时同时行HP治疗; B方式: HD第3、4小时同时行HP治疗),两种方式随机交替进行,间隔2周。每次CAK治疗前、后留取血清标本,同批检测各种毒素水平,根据超滤量和透析前体质量校正透析后各毒素水平。用CAK治疗后各毒素下降绝对值和下降百分数评价不同CAK方式的清除效率。结果 (1)两种CAK治疗后各毒素水平均比治疗前降低，差异均有统计学意义(P<0.01); (2)两种方式CAK对小分子毒素肌酐(SCr)和尿素氮(BUN)的清除效果差异无统计学意义(P＞0.05); (3)B方式CAK对中分子毒素全段甲状旁腺激素(iPTH)与β2-微球蛋白(β2-MG)的清除效果更好,表现为更大的下降绝对值和下降百分数(P<0.05); (4)B方式CAK对炎症因子白介素1(IL-1)、白介素6(IL-6)和肿瘤坏死因子α(TNF-α)的清除效果更好,表现为更大的下降绝对值和(或)下降百分数(P<0.05); (5)两种方式CAK对炎症因子C反应蛋白(CRP)和五聚素3(PTX-3)的清除效果差异无统计学意义(P＞0.05); (6)两种方式CAK低血压、凝血等不良事件的发生率差异无统计学意义(P＞0.05)。结论 两种CAK方式对MHD患者的尿毒症相关毒素均有较好的清除效果。两者相比较,B方式CAK对 iPTH、β2-MG、IL-1、IL-6和TNF-α的清除效果更好,且不增加不良事件发生率,有临床推广价值。 |
| 关键词: 血液透析 人工肾 血液灌流 时机选择 |
| DOI： |
| 投稿时间：2013-04-17修订日期：2013-09-25 |
| 基金项目:国家自然科学基金(81070547),上海市卫生局科研基金(WSJ1002). |
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| Timing of hemoperfusion during combined treatment with hemodialysis and hemoperfusion |
| LI Da ming,LI Jiang tao,XU Yan,CHEN Yue,WANG Ai li,YU Chen,XU Chen* |
(Department of Nephrology Medicine, Shanghai Tongji Hospital, Tongji University, Shanghai 200065, China
*Corresponding author.) |
| Abstract: |
| Objective To investigate the effect of timing of hemoperfusion (HP) on the efficiency of hemodialysis (HD) combined with HP, a kind of combined artificial kidney (CAK), in treating patients on maintenance hemodialysis. Methods Totally 20 end-stage renal disease patients undergoing hemodialysis (HD) (4 hours every time,3 times every week)for more than 3 months in the Blood Purification Department of Shanghai Tongji Hospital were enrolled in the present study from July 2012 to January 2013. All patients were alternately and randomly given two kinds of CAK (model A: HP was given during the first and second hours of HD; model B: HP was given during the third and forth hours of HD) in succession. Serum samples were harvested before and after CAK treatment and the toxin concentrations were measured in the same batch; the toxin concentrations after CAK were corrected by pre-treatment body weight and ultrafiltration quality. Efficiencies of different models of CAK were evaluated by the absolute and percentages of toxin concentration declines after treatment. Results All the toxins were significantly declined after treatment with both models of CAK (P<0.01). The clearance efficiencies for serum creatine (SCr) and blood urea nitrogen (BUN) were not significantly different between the two models (P＞0.05). The decreases of intact parathyroid hormone (iPTH) and β2-microglobulin (β2-MG) of model B were significantly greater than those of model A (P<0.05). Model B also led to significantly greater decline of interleukin-1(IL-1), interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α), either in absolute value and/or percentage (P<0.05). The declines of C-reactive protein (CRP) and pentraxin 3(PTX-3) and the incidences of adverse events (low blood pressure, blood coagulation and so on) were not significantly different between the two models(P＞0.05). Conclusion Both models of CAK are significantly efficient in eliminating uremic toxins for MHD patient. Comparatively, model B CAK have better performance for eliminating iPTH, β2-MG, IL-1, IL-6 and TNF-α, without increasing adverse events, and is worth of popularizing in clinic. |
| Key words: hemodialysis artificial kidney hemoperfusion opportunity for choice |
