高通量透析的效果及对患者生存率的影响

发布时间：2018-04-30 11:41

本文选题：高通量透析 + 中分子物质　；参考：《中国现代医学杂志》2017年11期

【摘要】：目的探讨高通量透析对中分子物质的清除作用及透析患者死亡的相关因素。方法选取2015年6月-2016年1月在该院血液净化中心行血液透析的216例慢性肾衰竭(尿毒症)患者,根据透析方式将患者随机分为高通量透析组(HF,n=104)和低通量透析组(LF,n=112),检测治疗前后血清肌酐(Cr)、尿素氮(BUN)、β2微球蛋白(β2-MG)、免疫反应性甲状旁腺激素(iPTH)及C反应蛋白(CRP)浓度水平,卡普兰-迈耶(Kaplan-Meier)生存曲线分析两组患者生存率,COX多因素回归分析影响患者死亡的危险因素。结果透析后,两组血清Cr、BUN、β2-MG、iPTH及CRP浓度均降低,HF组血清Cr、BUN、β2-MG及iPTH浓度低于LF组,HF组临床症状改善多于LF组(χ~2=5.782,P=0.016)。LF组死亡率高于HF组(χ~2=4.202,P=0.040),HF组累积生存率高于LF组(P=0.011),COX多因素回归分析结果显示透析类型、心血管疾病、肾小球滤过率(GFR)、血清Cr及β2-MG水平是影响透析患者死亡的危险因素。结论高通量透析(HFHD)能有效清除尿毒症患者体内中分子毒素,改善临床症状,降低透析患者死亡率,改善预后。
[Abstract]:Objective to investigate the effect of high-flux dialysis on the clearance of medium-molecular substances and the related factors of dialysate death. Methods 216 patients with chronic renal failure (uremia) who underwent hemodialysis from June 2015 to January 2016 were selected. The patients were randomly divided into high flux dialysis group (HFN 104) and low flux dialysis group (low flux dialysis group) according to the method of dialysis. The serum levels of creatinine, bun, 尾 2 microglobulin (尾 2-MGG), immunoreactive parathyroid hormone iPTHand C-reactive protein (CRP) were measured before and after treatment. Kaplan-Meier (Kaplan-Meier) survival curve analysis of survival rate and Cox multivariate regression analysis were used to analyze the risk factors of death. Results after dialysis, In both groups, the serum levels of Crubin, 尾 2-MGG, iPTH and CRP were lower in HF group than in LF group. The clinical symptoms of HF group were improved more than that of LF group (蠂 ~ 25.782). The mortality rate of LF group was higher than that of HF group (蠂 ~ 24.202P 0.040). The cumulative survival rate of HF group was higher than that of LF group. The results of multivariate regression analysis showed that the dialysate type was higher in HF group than in LF group. Cardiovascular disease, glomerular filtration rate (GFR), serum Cr and 尾 2-MG levels were risk factors for dialysate death. Conclusion HFHD can effectively remove molecular toxin, improve clinical symptoms, reduce mortality and improve prognosis in uremic patients.
【作者单位】：贵州省遵义市第一人民医院血液透析室;
【分类号】：R692.5

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