FX高通量血液透析对尿毒症患者生存质量改善作用的临床研究

发布时间：2018-03-04 09:19

  本文选题：高通量血液透析　切入点：毒素清除　出处：《安徽医科大学》2014年博士论文　论文类型：学位论文

【摘要】：第一部分高通量血液透析对尿毒症患者毒素清除、贫血、继发性甲旁亢、钙磷代谢、ET-1、NO、平均动脉压的影响目的:本研究旨在观察高通量血液透析和常规低通量血液透析对维持性血液透析患者毒素清除、贫血、继发性甲旁亢、钙磷代谢、ET-1、NO、平均动脉压的影响。对于尿毒症患者而言,体内各种大小不同的毒素分子对其生存质量具有重要影响。从这个角度出发,如何有效清除尿毒症患者体内的中、大分子具有重要的临床意义。目前,许多临床资料表明,高通量血液透析能够更好的清除尿毒症患者体内的大、中分子。但是,现在还没有足够的数据表明,这种对大、中分子的清除能够有效的改善尿毒症患者的一些并发症。因此,针对这一个问题,本部分主要从以下几个方面进行探讨,即高通量血液透析对毒素清除、贫血、继发性甲旁亢、钙磷代谢、ET-1、NO、平均动脉压的作用。方法:本文主要选取了安徽医科大学第三附属医院在2011年10月到2012年6月间进行尿毒症透析治疗的42例患者,并将21例随机分配到低通量血液透析组、另外21例分配到高通量血液透析组。另外,我们还选取了24例健康的正常对照组。高通量血液透析组患者使用聚砜膜透析器Fx60,而低通量血液透析组使用F7。所有患者每周透析三次,每次4-4.5个小时,并且透析时间均超过三个月,病情稳定。并且在透析过程中,尿毒症患者没有接受过输血或免疫抑制剂治疗,无外伤手术。我们分别抽取了高通量血液透析组和低通量血液透析组患者单次透析前后血样本,每次抽取5 ml。另外,我们还抽取了健康人群空腹血标本。然后,我们将这些抽取的血标本至于-80~-20oC进行保存。将以上血液标本进行离心后,我们分析了高通量血液透析组患者和低通量血液透析组患者体内的血清尿素(BUN)、血磷(P3+)、甲状旁腺素(intact parathyroid hormone,i PIH)、β2-微球蛋白(β2-microglobulin,β2-MG)水平,进而探讨高通量血液透析对毒素清除的影响。另外,我们还比较了HFHD和LFHD患者体内的血红蛋白(Hb)、红细胞压积(Hct)、血清白蛋白(ALB)、血肌酐(Scr)水平,进而反应其对贫血的改善作用。根据血液内甲状旁腺激素、钙、磷的变化水平,我们探讨了高通量血液透析对继发性甲旁亢、钙磷代谢的影响。而且,我们还比较了高通量血液透析后患者ET-1、Ang II、NO及平均动脉压变化的情况。结果1.经过高通量血液透析以后,患者体内的BUN、Scr、血磷、β2-MG下降水平明显,因此,与常规的低通量血液透析相比,单次的高通量血液透析不仅表现出类似的对小分子物质清除率,而且能够更好的清除P3+、i PTH、β2-MG等大、中分子,差异具有明显的统计学意义(P均0.05)。2.高通量血液透析6个月以后,患者体内的血红蛋白(Hb)、红细胞压积(Hct)明显高于常规透析组(P均0.05)。3.高通量血液透析6个月以后,患者体内的血磷、甲状旁腺激素明显下降。相较于低通量血液透析,我们的数据表明高通量血液透析能够更加有效的清除血液中的甲状旁腺激素。而且,清除效果与常规低通量血液透析相比具有明显的统计学差异(P0.05)。4.高通量血液透析6个月以后,患者体内的内皮素-1的水平明显下降并能够升高血液中NO的水平(P0.05)。结论1.高通量血液透析可以更好的清除P3+、i PTH、β2-MG。2.高通量血液透析可以使尿毒症患者的贫血状况得到明显改善。3.高通量血液透析能够使尿毒症患者继发性甲状旁腺机能亢进得到控制。4.高通量血液透析可以使血液透析患者血液中的内皮素、NO等分子能够得到有效调节,进而改善血管内皮细胞功能,从而有利于患者血压的控制。第二部分高通量血液透析对尿毒症患者营养不良、微炎症以及肺功能、生活质量评分的影响目的:本研究旨在观察高通量血液透析和常规低通量血液透析对维持性血液透析患者营养不良、炎症以及肺功能、生活质量评分的影响。与常规低通量血液透析相比,高通量血液透析可以通过弥散、对流和吸附等方法,有效促进大、中分子的清除。但是,现在还没有足够的数据表明,这种对大、中分子的清除能够有效的改善尿毒症患者的一些远期并发症。因此,针对这一个问题,本部分主要从以下几个方面进行探讨,即高通量血液透析对营养不良、炎症以及肺功能、生活质量评分的影响。方法:本文主要选取了安徽医科大学第三附属医院在2011年10月到2012年6月间进行尿毒症透析治疗的42例患者,并将21例随机分配到低通量血液透析组、另外21例分配到高通量血液透析组。另外,我们还选取了24例健康的正常对照组。高通量血液透析组患者使用聚砜膜透析器Fx60,而低通量血液透析组使用F7。所有患者每周透析三次,每次4-4.5个小时,并且透析时间均超过三个月,病情稳定。并且在透析过程中,尿毒症患者没有接受过输血或免疫抑制剂治疗,无外伤手术。我们分别抽取了高通量血液透析组和低通量血液透析组患者单次透析前后血样本,每次抽取5 ml。另外,我们还抽取了健康人群空腹血标本。然后,我们将这些抽取的血标本至于-80~-20oC进行保存。将以上血液标本进行离心后,测定体内血清白蛋白(ALB)、血脂、C-反应蛋白(CRP)、白介素-6(IL-6)等的浓度,同时,通过测定SGA、TSF、MAC、MAMC来探讨高通量血液透析对于改善透析患者营养不良、微炎症反应的作用。此外,由于肺脏是尿毒症最常受累的脏器之一,尿毒症患者肺功能可能会受到多方面的影响。我们通过对比低通量血液透析患者和高通量血液透析患者的的肺功能情况,从而探讨尿毒症患者肺功能损害特征及高通量透析治疗对其肺功能的影响。为了探讨高通量透析对尿毒症患者生活质量的影响,我们用SF-36量表评估了患者的生存质量。结果1.高通量血液透析6个月以后,患者体内的血清白蛋白、HDL、TSF、MAMC水平升高(P0.05),而CHOL、TG、LDL水平下降(P0.05)。而且,透析6个月后,患者体内的IL-6水平明显下降(P0.05)。2.高通量血液透析3个月以后,患者的肺功能状态得到了一定程度的改善。观察组和对照组的FVC、MBC、FEV1、FEF、MMEF、V25、DLCO均明显低于正常组(P0.05)。与治疗前相比,治疗后观察组和对照组的FEV1、PEF、MMEF、V25均明显升高(P0.05),而FVC、MBC、DLco均无明显变化(P0.05)。同时观察组的FEV1、PEF、MMEF、V25变化幅度大于对照组(P0.05),而FVC、MBC、DLco组间差异没有显著性(P0.05)。3.高通量血液透析6个月以后,生活质量调查PCS、PF、RP、BP、RE五个维度的得分明显高于治疗前,并且具有统计学意义。而MCS、GH、SF、MH、VT的得分在治疗前后没有明显的改变。结论1.高通量血液透析能够改善患者体内的营养不良及炎症状态。由于炎症与动脉硬化密切相关,因此,高通量血液透析从一定程度上能够改善患者的血管硬化情况。2.尿毒症患者存在肺通气及弥散功能的降低,伴气道阻塞。高通量血液透析治疗能显著改善气道阻塞,但对肺通气及弥散功能无明显改善。3.高通量血液透析对尿毒症患者的生存质量评分有一定改善。
[Abstract]:The first part of high flux hemodialysis on toxin elimination of patients with uremia, anemia, secondary hyperparathyroidism, metabolism of calcium and phosphorus, ET-1, NO, influence of mean arterial pressure. Objective: This study aimed to investigate high flux hemodialysis and conventional low flux hemodialysis on maintenance hemodialysis patients with anemia, toxin removal, secondary hyperparathyroidism beside the Kang, calcium and phosphorus metabolism, ET-1, NO, influence of mean arterial pressure. For uremic patients, has an important influence on various toxin molecules in vivo on the quality of life. From this perspective, how to effectively remove the body in patients with uremia, has important clinical significance for large molecules. At present, many clinical data show that high flux hemodialysis can better remove the body of patients with uremia in large molecules. However, there is not enough data to show that the large clearance of molecules can effectively improve the urine Some complications in patients with sepsis. Therefore, to solve this problem, this part mainly discusses from the following aspects, namely high flux hemodialysis for toxin removal, anemia, secondary hyperparathyroidism, metabolism of calcium and phosphorus, ET-1, NO, mean arterial pressure. Methods: This paper selected Affiliated Hospital Medical University Of Anhui in October 2011 third to June 2012 42 cases of uremic dialysis patients, and 21 patients were randomly assigned to low flux hemodialysis group, another 21 cases assigned to high flux hemodialysis group. In addition, we also selected 24 cases of healthy control group. High amount of Fx60 dialyzer in hemodialysis group patients and low flux hemodialysis group using F7. all patients every week dialysis three times, each time 4-4.5 hours, and dialysis time was longer than three months, a stable condition. And in the process of dialysis in uremic patients. Have not received blood transfusion or immunosuppressive therapy, no trauma surgery. We were collected before and after a single dialysis of high flux hemodialysis group and low flux hemodialysis patients blood samples, each sample of 5 ml. in addition, we also selected healthy fasting blood samples. Then, we will extract these blood samples for -80~-20oC the blood samples were preserved. After centrifugation, we analyzed the high flux hemodialysis group and low flux hemodialysis group patients serum urea (BUN), phosphorus (P3+), parathyroid hormone (intact parathyroid hormone, I PIH), beta 2- microglobulin (beta beta 2-microglobulin, 2-MG) level. And then discuss the influence of high flux hemodialysis on toxin removal. In addition, we also compared the HFHD patients and LFHD hemoglobin (Hb), hematocrit (Hct), serum albumin (ALB), serum creatinine (Scr) level, Then the reaction effect on improvement of anemia. According to blood parathyroid hormone, calcium and phosphorus levels, we investigate the high flux hemodialysis on secondary hyperparathyroidism, effects of calcium and phosphorus metabolism. Moreover, we also compared the ET-1 patients with high flux hemodialysis after Ang II, the changes of NO and average artery pressure. Results 1. after high flux hemodialysis patients, BUN, Scr, serum phosphorus, 2-MG decreased significantly, therefore, compared with the conventional low flux hemodialysis, high flux dialysis blood single not only showed a similar to the small molecule clearance, and can better remove P3+, I, PTH, 2-MG and other large molecules in the beta, and the difference is significant (P 0.05).2. high flux hemodialysis after 6 months, the patient's hemoglobin (Hb), hematocrit (Hct) was significantly higher than that of conventional hemodialysis group (P 0.05).3. Qualcomm The amount of blood dialysis 6 months later, the patient's serum phosphorus, parathyroid hormone decreased significantly. Compared with low flux hemodialysis, our data suggest that high flux hemodialysis can effectively remove blood parathyroid hormone. Moreover, scavenging effect with conventional low-pass hemadialysis compared with significant difference (P0.05.4.) high flux hemodialysis after 6 months, significantly decreased levels of -1 in patients with endothelial and can increase blood levels of NO (P0.05). Conclusion: 1. high flux hemodialysis can better remove P3+, I PTH, beta 2-MG.2. high flux hemodialysis can make anemia in uremic patients was significantly improved.3. high flux hemodialysis can make uremic patients with secondary hyperparathyroidism under control of.4. high flux hemodialysis can make endothelial blood in hemodialysis patients, NO Such molecules can regulate effectively, and improve the function of vascular endothelial cells to help control blood pressure. The second part of high flux hemodialysis on uremic patients with malnutrition, inflammation and lung function, affect the quality of life score Objective: the purpose of this study is the observation of high flux hemodialysis and conventional low flux hemodialysis on maintenance hemodialysis patients with malnutrition, inflammation and lung function, affecting the quality of life score. Compared with the conventional low flux hemodialysis, high flux hemodialysis by diffusion, convection and adsorption methods, effectively promote the large clearance of molecules. However, there is not enough data to show that the large, clear the molecular can effectively improve the long-term complications of uremia patients. Therefore, to solve this problem, this part mainly discusses from the following aspects, High flux hemodialysis on malnutrition, inflammation and lung function, affecting the quality of life score. Methods: This paper selected the Third Affiliated Hospital of Medical University Of Anhui from October 2011 to June 2012 were 42 cases of uremic dialysis patients, and 21 patients were randomly assigned to low flux hemodialysis group, another 21 cases assigned to high flux hemodialysis group. In addition, we also selected 24 cases of healthy control group. High amount of Fx60 dialyzer in hemodialysis patients, and low flux hemodialysis group using F7. all patients every week dialysis three times, each time 4-4.5 hours, and dialysis time was longer than three months, and in a stable condition. In the process of dialysis, uremic patients did not receive blood transfusion or immunosuppressive therapy, no trauma surgery. We selected high flux hemodialysis group and low flux hemodialysis Before and after single dialysis patients blood samples, each sample of 5 ml. in addition, we also selected healthy fasting blood samples. Then, we will extract these blood samples for -80~-20oC were preserved. The blood samples were centrifuged and the in vivo assay of serum albumin (ALB), blood lipids, C- reactive protein (CRP). Interleukin -6 (IL-6) and the concentration, at the same time, through the determination of SGA, TSF, MAC, MAMC of high flux hemodialysis to improve hemodialysis patients with malnutrition, micro inflammatory reaction. In addition, the lung is one of the most commonly involved organs of uremia and pulmonary function in patients with uremia may be affected by many factors we compared the low flux hemodialysis and high throughput pulmonary function of the patients with hemodialysis in uremic patients, so as to explore the lung function damage characteristics and effect of high flux hemodialysis on the pulmonary function in order to explore. 璁ㄩ珮閫氶噺閫忔瀽瀵瑰翱姣掔棁鎮ｈ，

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