血液透析联合血液灌流治疗对维持性血液透析患者的影响

论著血液透析联合血液灌流治疗对维持性血液透析患者的影响

张颖娟，薛琳，张家菊，罗建琼，文鸿，王萍

（攀枝花市中心医院肾内科，四川攀枝花617067）

【摘要】目的探讨血液透析联合血液灌流治疗能否提高维持性血透患者中大分子毒素的清除，以及对患者贫血、

血压、皮肤瘙痒的影响。方法采用前瞻性、自身前后对照研究，选取56名维持性血透患者，先予血液透析(HD组)治疗

观察3个月，每周行HD3次;然后改为血液透析+血液灌流(HD+HP组)治疗3个月，每周2次HD及1次HD+HP。观察

患者血压、皮肤瘙痒情况，同时检测血全段甲状旁腺激素(iPTH)、β2-微球蛋白(β2-MG)、C反应蛋白(CRP)、胱抑素C (CysC)、清蛋白(ALB)、血红蛋白(HGB)。结果治疗3个月后，与HD组比较，HD+HP组血压控制达标者较多(P＜

0.05)，皮肤瘙痒改善率较高(P＜0.01)，血iPTH、β2-MG、CRP、CysC均明显降低(P＜0.01)，HGB明显升高(P＜0.05)。两

组患者在治疗过程中均无不良反应发生。结论HD联合HP治疗与单独HD相比，更能有效清除大中分子尿毒症毒素，

改善患者生活质量。

【关键词】血液透析;血液灌流;中大分子毒素

【中图分类号】R459.5【文献标识码】A【文章编号】1004-0501(2012)12-2112-03

Influence of hemodialysis in combination with hemoperfusion on patients with maintenance hemodialysis．ZHANG Ying-juan，XUE Lin，ZHANG Jia-ju，et al．The Central Hospital of Panzhihua，Panzhihua，Sichuan617067，China 【Abstract】Objective To investigate whether hemodialysis in combination with hemoperfusion improve the clearance rate

of middle-and large-molecule uremic toxins so as to have effect on anemia，blood pressure（BP）and itchy skin in patients with ma-intenance hemodialysis．Methods A prospective，self control study was carried out．Fifty six patients were selected to receive he-modialysis three times a week（HD group）for3months and then hemodialysis twice a week plus hemodialysis in combination with hemoperfusion once a week（HD+HP group）for the next3months．Blood pressure and the severity of itchy skin were recorded．Hemoglobin，albumin，iPTH，β2-MG，CRP，CysC in blood were detected．Results At the end of the3-months observation，more patients in HD+HP group got well-controlled BP（P＜0.05）and improved itchy skin（P＜0.01）than HD group．Compared to HD group，the level of iPTH，β2-MG，CRP and CysC in blood were significantly lower（P＜0.01）and hemoglobin higher（P＜0.05）in

HD+HP group．There was no adverse effect occurred during treatment in both groups．Conclusion Hemodialysis in combination

with hemoperfusion is superior to hemodialysis alone in eliminating middle-and large-molecules uremic toxins and improving the quality of life in patients with maintenance hemodialysis．

【Key words】hemodialysis；hemoperfusion；middle-and large-molecule toxins

血液灌流（hemoperfusion，HP）是将血液借助体外循环，引入装有固态吸附剂的容器中，应用吸附的原理清除某些外源性或内源性的毒物，达到血液净化的一种治疗方法。目前已被证明的尿毒症毒素种类在200种以上［1］，随着透析时间的延长，各种中大分子毒素不断蓄积，是引起尿毒症维持性血液透析患者各种并发症的主要原因，严重影响患者的生存质量。单纯血液透析（hemodialysis，HD）对中大分子物质清除率低，血液灌流对脂溶性高、易与蛋白质结合的药物和毒物，以及中大分子物质的清除效果要明显优于HD。本研究旨在观察树脂型血液灌流与血液透析联合应用，对维持性血液透析患者体内一些中大分子尿毒症毒素水平的影响。1资料与方法

1.1一般资料：选择于我院血液净化中心维持性血液透析患者，病情稳定，透析龄≥6个月，排除急性感染、血管炎、肝炎病毒携带者、肿瘤及其它活动性疾病。纳入患者56例，男30例，女26例，平均年龄（48.5ʃ17.8）岁，原发病为慢性肾小球肾炎27例，糖尿病肾病18例，药物性肾病3例，痛风性肾病3例，高血压肾病3例，梗阻性肾病1例，多囊肾1例。平均透析龄（3

2.3ʃ15.8）个月。

1.2方法

1.2．1分组及治疗方法：采用自身前后对照方案，先予血液透析（HD组）治疗观察3个月，选用poly-