CAJ | 학술논문

目的探讨维持性血液透析(MHD)联合血液灌流(HP)治疗能否提高中、大分子毒素的清除率,能否改善MHD患者的生活质量并降低其病死率.方法采用前瞻性、随机、对照性研究.选取100例MHD患者,4周试验导入期后随机分为2组.HD+HP组(n=51)采取维持性单纯血液透析(2次/周)和HD+HP(1次/周)治疗;HD组(n=49)采取单纯血液透析(3次/周)治疗.平均随访2年.主要观察终点为患者死亡;次要观察终点为常规临床指标、瘦素、超敏C反应蛋白(hsCRP)、白细胞介素6(IL-6)、β2微球蛋白(β2-MG)、甲状旁腺激素(PTH)、肿瘤坏死因子α(TNF-α)和SF-36量表生活质量指数.结果 2年观察期结束时,HD+HP组患者的瘦素、hsCRP、PTH、IL-6、β2-MG和TNF-α的血清浓度和收缩压、舒张压、心率、心胸比、左室质量指数(LVMI)、EPO剂量和降压药的种类均低于HD组(均P＜0.05);HD+HP组患者的血红蛋白(Hb)浓度、左心室射血分数(EF)、体质量指数(BMI)均高于HD组(均P＜0.05);2组患者的血清白蛋白(Alb)浓度、血清铁(SI)浓度、总铁结合力(TIBC)、Kt/V、每分心输出量(CO)和二尖瓣峰值流速比(E/A)差异均无统计学意义.2年观察期结束后,SF-36量表显示HD+HP组患者的生活质量明显好于HD组,总评价值显示HD+HP组患者总分高于HD组(P＜0.05).2年观察期间的Kaplan-Meier生存曲线显示HD+HP组患者具有明显的生存优势,Log-rank检验P＜0.05.HD+HP组患者行HD+HP时未发生严重的不良反应.结论 HD+HP清除患者体内中大分子毒素的效果明显优于单纯性HD,同时在改善MHD患者的生活质量和提高其生存率方面有潜在的优势.
목적 탐토유지성혈액투석(MHD)연합혈액관류(HP)치료능부제고중、대분자독소적청제솔,능부개선MHD환자적생활질량병강저기병사솔.방법 채용전첨성、수궤、대조성연구.선취100례MHD환자,4주시험도입기후수궤분위2조.HD+HP조(n=51)채취유지성단순혈액투석(2차/주)화HD+HP(1차/주)치료;HD조(n=49)채취단순혈액투석(3차/주)치료.평균수방2년.주요관찰종점위환자사망;차요관찰종점위상규림상지표、수소、초민C반응단백(hsCRP)、백세포개소6(IL-6)、β2미구단백(β2-MG)、갑상방선격소(PTH)、종류배사인자α(TNF-α)화SF-36량표생활질량지수.결과 2년관찰기결속시,HD+HP조환자적수소、hsCRP、PTH、IL-6、β2-MG화TNF-α적혈청농도화수축압、서장압、심솔、심흉비、좌실질량지수(LVMI)、EPO제량화강압약적충류균저우HD조(균P＜0.05);HD+HP조환자적혈홍단백(Hb)농도、좌심실사혈분수(EF)、체질량지수(BMI)균고우HD조(균P＜0.05);2조환자적혈청백단백(Alb)농도、혈청철(SI)농도、총철결합력(TIBC)、Kt/V、매분심수출량(CO)화이첨판봉치류속비(E/A)차이균무통계학의의.2년관찰기결속후,SF-36량표현시HD+HP조환자적생활질량명현호우HD조,총평개치현시HD+HP조환자총분고우HD조(P＜0.05).2년관찰기간적Kaplan-Meier생존곡선현시HD+HP조환자구유명현적생존우세,Log-rank검험P＜0.05.HD+HP조환자행HD+HP시미발생엄중적불량반응.결론 HD+HP청제환자체내중대분자독소적효과명현우우단순성HD,동시재개선MHD환자적생활질량화제고기생존솔방면유잠재적우세.
Objective To investigate whether the combination of maintenance hemodialysis (MHD) with hemoperfusion(HP) can improve the clearance rate of middle- and largemolecule uremic toxins so as to improve the quality of life and reduce the mortality in MHD patients. Methods A prospective, randomized and controlled clinical trial was carried out. One hundred MHD patients were selected and then randomly divided into two groups after four weeks of run-in period. HD+HP group received MHD alone 2 times a week and the combined treatment of HD with HP (HD+HP) once a week, whereas HD group received MHD alone 3 times a week. The follow up lasted for mean 2 years. The primary outcome was the death of patients. Secondary end points included clinical data, leptin, high sensitive C-reactive protein (hsCRP), interleukin 6 (IL-6),β2 microglobulin (β2-MG), parathyroid hormone (PTH), tumor necrosis factor α (TNF-α) and the indexes of dimensions of Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36Chinese Edition ). Results At the end of the two-year observation, the serum concentration of leptin, hsCRP, PTH, IL-6, β2-MG and TNF-α, systolic blood pressure (SBP), diastolic blood pressure(DBP), heart rate(HR), cardiothoracie ratio, left ventricular mass index (LVMI), EPO dose and the types of antihypertensive drugs used were lower in HD +HP group as compared to HD group (all P＜0.05). HD+HP group had higher hemoglobin (Hb), ejection fraction (EF) and body mass index (BMI) (all P＜0.05). No significant differences between two groups were found in terms of serum albumin (Alb), serum iron (SI), total iron binding capacity (TIBC), cardiac output (CO),Kt/V, early/atrial mitral inflow velocities (E/A) (all P＞0.05). Besides, the SF-36 indicated that the total score of overall dimensions in HD+HP group was higher (P＜0.05) and the quality of life of HD+HP group was evidently better as compared to HD group. The Kaplan-Meier survival curves for the 2-year observation period showed that patients in HD +HP group had obvious survival advantage, while Log-rank test results showed P＜0.05. No serious adverse incidents occurred during the HD+HP treatment. Conclusion HD+HP is superior to HD in eliminating regularly middleand large-molecules uremic toxins and has a potential role in improving the quality of life and survival rate of MHD patients.