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目的探讨高通量血液透析对尿毒症患者体内毒素清除效果。方法选择2013年2月—2016年2月在本院进行维持性血液透析治疗的52例尿毒症患者作为调查对象,按照随机数字表法分为观察组和对照组各26例。观察组行高通量血液透析治疗,对照组行低通量血液透析治疗。观察两组患者的尿素氮(blood urea nitrogen,BUN)、血肌酐(serum creatinine,Scr)、C反应蛋白(C-reactive protein,CRP)、β2微球蛋白、半胱氨酸蛋白酶抑制剂、甲状旁腺激素含量、尿素清除指数、标准蛋白质分解代谢率及时间平均尿素浓度。计量资料比较采用t检验,P<0.05为差异有统计学意义。结果与治疗前比较[(23.64±6.17)mmol/L、(812.37±73.27)μmol/L、(18.96±5.08)mg/L,(24.08±5.62)mmol/L、(813.61±73.93)μmol/L、(18.87±5.12)mg/L],治疗后两组患者小分子毒素和炎症介质清除效果均有改善[(9.23±2.26)mmol/L、(353.74±62.15)μmol/L、(10.03±4.56)mg/L,(9.45±2.11)mmol/L、(358.48±66.53)μmol/L、(10.15±4.35)mg/L],差异均有统计学意义(均P<0.05)。治疗后两组患者大中分子毒素清除效果均显著改善[(9.25±2.06)mg/L、(2.15±0.86)mmol/L、(435.97±35.21)pg/ml,(11.99±3.17)mg/L、(2.98±0.54)mmol/L、(493.75±39.66)pg/ml],组间比较差异均有统计学意义(均P<0.05)。两组患者尿素清除指数、标准蛋白质分解代谢率、时间平均尿素浓度[(1.21±0.35)、(3.14±0.72)g·kg-1·d-1、(16.25±6.37)mmol/L,(1.23±0.41)、(3.10±0.76)g·kg-1·d-1、(16.38±6.23)mmol/L比较,差异均无统计学意义(均P>0.05)。结论高通量血液透析对大中分子毒素的清除效果较好,对小分子毒素和炎症物质的清除效果与低通量血液透析方法相当。
Objective To investigate the effect of high-flux hemodialysis on toxin removal in uremic patients. Methods 52 patients with uremia who underwent maintenance hemodialysis in our hospital from February 2013 to February 2016 were selected as subjects and divided into observation group and control group according to random number table. The observation group received high-flux hemodialysis and the control group received low-flux hemodialysis. Blood urea nitrogen (BUN), serum creatinine (Scr), C-reactive protein (CRP), β2 microglobulin, cysteine protease inhibitor, Parathyroid hormone content, urea clearance index, standard protein catabolism rate and time average urea concentration. Measurement data were compared using t test, P <0.05 for the difference was statistically significant. The results were compared with before treatment [(23.64 ± 6.17) mmol / L, (812.37 ± 73.27) μmol / L, (18.96 ± 5.08) mg / L, (24.08 ± 5.62) mmol / L, (813.61 ± 73.93) μmol / L , (18.87 ± 5.12) mg / L, respectively]. After treatment, the clearance of small molecule toxin and inflammatory mediators were improved in both groups (9.23 ± 2.26 mmol / L, 353.74 ± 62.15 μmol / L, (9.45 ± 2.11) mmol / L, (358.48 ± 66.53) μmol / L and (10.15 ± 4.35) mg / L respectively), all of which were statistically significant (all P <0.05). After treatment, the clearance effect of large and medium molecular toxins was significantly improved in both groups [(9.25 ± 2.06) mg / L, (2.15 ± 0.86) mmol / L, (435.97 ± 35.21) pg / ml and (11.99 ± 3.17) mg / L , (2.98 ± 0.54) mmol / L, (493.75 ± 39.66) pg / ml] respectively. There was significant difference between the two groups (all P <0.05). The urinary clearance index, standard protein catabolism rate and time-average urea concentration in the two groups [(1.21 ± 0.35), (3.14 ± 0.72) g · kg-1 · d-1, (16.25 ± 6.37) mmol / (P <0.05). There was no significant difference between the two groups (P> 0.05). There was no significant difference between the two groups (P 0. 05) and (3.10 0.76) g · kg -1 · d -1, (16.38 ± 6.23) mmol / L. Conclusions High-throughput hemodialysis is effective in removing large-to-medium molecular toxins. The removal efficiencies of small molecule toxins and inflammatory substances are comparable to those of low-throughput hemodialysis.