| 摘要: |
| ［摘要］ 目的 比较高通量血液透析（HFHD）、血液透析滤过（HDF）和维持性血液透析（CHD）对肾衰竭患者肾功能相关中、大分子物质的清除效果。方法 招募2021年1月至2022年12月中国人民解放军联勤保障部队第九八三医院收治的、接受规律血液透析治疗的肾衰竭患者100例。患者肾功能相关中、大分子物质持续高水平，经充分告知患者病情后，根据其治疗意愿分为CHD组（33例）、HDF组（33例）和HFHD组（34例）。比较三组调整透析模式前及调整透析模式后6个月的肾功能相关小分子物质（肌酐、尿素氮、磷）、肾功能相关中、大分子物质（白蛋白、β2微球蛋白、C反应蛋白）以及氧化应激指标（丙二醛、超氧化物歧化酶、过氧化氢酶、硫氧还蛋白）的水平，并记录三组并发症发生情况。结果 调整透析模式后，三组肌酐、尿素氮、磷水平显著低于调整前（P<0.05），但三组间比较差异无统计学意义（P>0.05）。调整透析模式后，三组白蛋白、超氧化物歧化酶、过氧化氢酶、硫氧还蛋白水平较调整前显著升高（P<0.05），β2微球蛋白、C反应蛋白、丙二醛水平较调整前显著降低（P<0.05）。HDF组调整透析模式后的β2微球蛋白、C反应蛋白、丙二醛水平显著低于CHD组和HFHD组（P<0.05），超氧化物歧化酶、过氧化氢酶、硫氧还蛋白水平显著高于CHD组和HFHD组（P<0.05），三组白蛋白水平比较差异无统计学意义（P>0.05）。CHD组、HDF组和HFHD组的并发症总发生率分别为18.18%、12.12%和14.71%，差异无统计学意义（χ2=0.478，P=0.788）。结论 HFHD、HDF、CHD三种透析中以HDF在清除肾功能相关中、大分子物质和改善氧化应激状态方面的效果最佳，且安全性良好。 |
| 关键词: 肾衰竭 高通量血液透析 血液透析滤过 维持性血液透析 β2微球蛋白 C反应蛋白 |
| DOI：10.3969/j.issn.1674-3806.2025.05.13 |
| 分类号:R 459.5 |
| 基金项目:河北省医学科研课题计划项目（编号：20200848） |
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| Comparison of effects of three dialysis modes on clearance of mid-molecule substance and macromolecular substance related to renal function in patients with renal failure |
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Yawei1, LIU Ping2
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1.Department of Cardiology and Nephrology, the 983rd Hospital of Joint Logistic Support Force of PLA, Tianjin 300142, China; 2.Department of Nephrology, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang 050000, China
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| Abstract: |
| ［Abstract］ Objective To compare the effects of high-flux hemodialysis(HFHD), hemodiafiltration(HDF) and continuous hemodialysis(CHD) on clearance of mid-molecule substance and macromolecular substance related to renal function in patients with renal failure. Methods A total of 100 patients with renal failure who were admitted to the 983rd Hospital of Joint Logistic Support Force of PLA from January 2021 to December 2022 and received regular hemodialysis treatment were recruited. These patients′ mid-molecule substance and macromolecular substance related to renal function remained at sustained high levels. After fully informing the patients of their conditions, they were divided into CHD group(33 cases), HDF group(33 cases) and HFHD group(34 cases) according to their treatment wishes. The levels of small-molecule substance related to renal function(creatinine, urea nitrogen, phosphorus), mid-molecule substance and macromolecular substance related to renal function(albumin, β2-microglobulin, C-reactive protein), and oxidative stress indicators［malondialdehyde(MDA), superoxide dismutase(SOD), catalase, thioredoxin］ were compared among the three groups before adjusting the dialysis modes and 6 months after adjusting the dialysis modes. The occurrence of complications in the two groups were recorded. Results After adjusting the dialysis modes, the levels of creatinine, urea nitrogen and phosphorus in the three groups were significantly lower than those before adjusting the dialysis modes(P<0.05), but there were no statistically significant differences in the levels of creatinine, urea nitrogen and phosphorus among the three groups after adjusting the dialysis modes(P>0.05). After adjusting the dialysis modes, the levels of albumin, SOD, catalase and thioredoxin in the three groups were significantly increased compared with those before adjusting the dialysis modes(P<0.05), and the levels of β2-microglobulin, C-reactive protein and MDA in the three groups were significantly decreased compared with those before adjusting the dialysis modes(P<0.05). After adjusting the dialysis modes, the levels of β2-microglobulin, C-reactive protein and MDA in the HDF group were significantly lower than those in the CHD group and the HFHD group(P<0.05). After adjusting the dialysis modes, the levels of SOD, catalase and thioredoxin in the HDF group were significantly higher than those in the CHD group and the HFHD group(P<0.05). After adjusting the dialysis modes, there was no statistically significant difference in the level of albumin among the three groups(P>0.05). The total incidence of complications in the CHD group, the HDF group and the HFHD group was 18.18%, 12.12% and 14.71% respectively, and there was no statistically significant difference in the total incidence of complications among the three groups(χ2=0.478, P=0.788). Conclusion Among the three dialysis modes of HFHD, HDF and CHD, HDF is the most effective in clearing the mid-molecule substance and macromolecular substance related to renal function and is the most effective in improving the oxidative stress state, and has good safety. |
| Key words: Renal failure High-flux hemodialysis(HFHD) Hemodiafiltration(HDF) Continuous hemodialysis(CHD) β2 -microglobulin C-reactive protein |
