| 摘要: |
| 目的：探讨不同残存尿量水平患者接受高通量或低通量透析获益差异。
方法：采用回顾性病例对照设计。选取沈阳军区总医院血液净化中心第一血液透析室维持性血液透析患者。按24小时残存尿量多少分组(尿量<300ml或≥300ml)，比较尿毒症毒素水平差异。再按照是否使用高通量透析器进行亚组分析，比较高低通透析对不同残存尿量水平患者的临床指标影响及差异。
结果：对比发现残存尿量较多患者倾向于更低的透析频次(P=0.031)，体重指数(P=0.015)显著更高，血清肌酐 (P=0.033)、胱抑素C (P=0.002)、β2微球蛋白 (P=0.000)、铁蛋白(P=0.012)水平显著更低。对于残存尿量较少患者：使用高通量透析器者β2微球蛋白水平(P=0.000)及铁蛋白水平(P=0.043)显著较低，但甲状旁腺激素水平(P=0.023)及体重水平 (P=0.049) 显著较高。对于残存尿量较多患者：使用高低通量透析β2微球蛋白水平(P=0.439)与甲状旁腺激素(P=0.190)水平无显著差异。
结论：使用高通量透析可获得更好的β2微球蛋白清除效果。高通量透析有助于维持更好的体重及体重指数，高通量透析对于不同残存尿量水平患者的生物学效应存在差异。残存尿量较少的患者使用高通量透析获益更多。 |
| 关键词: 24 h残存尿量 维持性血液透析 高通量透析 β2微球蛋白 甲状旁腺素 |
| DOI：10.3724/SP.J.1008.2015.01388 |
| 投稿时间：2015-02-11修订日期：2015-04-14 |
| 基金项目:全军医学科技青年培育项目计划课题(13QNP002),辽宁省科技攻关计划(2012408002). |
|
| Effects of residual renal function on uremic toxicity level of patients undergoing high-flux dialysis |
| HAO Jun-fengΔ,REN Kai-mingΔ,ZHANG Xiao-ling,WEI Xue-ting,BAI Jiu-xu,CAO Ning* |
(Department of Blood Purification, General Hospital PLA Shenyang Military Area Command, Shenyang 110015, Liaoning, China
△Co-first authors.
*Corresponding author.) |
| Abstract: |
| Objective: Our study aimed to determine interaction of residual urine volume with dialyzer membrane flux on uremic toxicity in HD patients.
Methods: This is a retrospective case-control study. Two hundred and five patients on maintenance hemodialysis in our blood purification center were included and divided into two groups of 24 h-urine volume<300 ml and 24 h-urine volume ≥ 300 ml. The patients were further divided into high-flux and low-flux dialysis groups according to the type of dialysis membrane used in each group. Baseline demographic, clinical data and laboratory values were recorded and compared in each group.
Results: Patients with 24 h-residual urine volume ≥ 300 ml preferred a higher dialysis frequency (P>0.031). Body mass index(P=0.015) were significantly higher in patients with 24 h-residual urine volume ≥ 300 ml, in whom serum creatinine(P=0.033), cystatin C(P=0.002), β2-microglobulin(P=0.000) and ferritin(P=0.012) levels were significantly lower. The pre-dialysis β2-microglobulin(P=0.000) and ferritin(P=0.043) levels were significantly lower in the high-flux subgroup in patients with 24 h-residual urine volume < 300 ml, but pre-dialysis intact parathyroid hormone (P=0.049) level and body mass index (P=0.023) were significantly higher in the high-flux subgroup. Levels of serum β2-microglobulin (P=0.439) and intact parathyroid hormone (P=0.190) were not significantly different between high- and low-flux subgroups in patients with 24 h-residual urine volume ≥ 300 ml.
Conclusion: High-flux dialysis was more efficient in removal of β2-microglobulin and maintenance of body mass index. Benefits of hemodialysis using high-flux membrane differed in patients with 24 h-residual urine volume < 300 ml and ≥ 300 ml. High-flux dialysis could provide more benefits in HD patients with 24 h-residual urine volume < 300 ml. |
| Key words: 24 h-residual urine volume maintenance hemodialysis high flux hemodialysis β2-microglobulin parathyroid hormone |
