CAJ | 학술논문

【目的】探讨高通量血液透析（HFHD）在终末期肾脏病（ ESRD）患者中的应用价值。【方法】收集血液透析时间在1年以上的136例ES RD患者的临床资料，根据透析器超滤系数的不同分为三组：超滤系数11．3 mL/（h · mmHg）的低通量8LR组（A组）；超滤系数50 mL/（h · mmHg）的高通量PS15组（B组）；超滤系数71 mL/（h · mmHg）的高通量17R组（C组）。比较三组血液透析前后的血尿素氮（BUN）、肌酐（SCr）、血磷（P3＋）、血钾（K＋）、血清甲状旁腺激素（iPTH）、β2-微球蛋白（β2-MG）、血清白蛋白（ALB）、瘦素（LP）、同型半胱氨酸（Hcy）、维生素B12（Vit B12）等指标，并分析比较各组血液透析后关节病变、腕管综合征、心血管系统等并发症。【结果】三组血BUN、SCr、P3＋、K＋等小分子物质比较无显著性差异（ P ＞0．05）；而B、C组iPTH、β2-MG、ALB、LP、Hcy、Vit B12等中大分子物质的清除则优于A组（ P ＜0．05），且C组对中大分子毒素的清除率最高（P＜0．05）；B、C组关节病变、腕管综合征、心血管系统并发症明显少于A组（P＜0．05），而低血压病的发生率高于A组（P ＜0．05），但三组感染率、病死率比较无统计学差异（P ＞0．05）。【结论】HF-HD与低通量血液透析（LFHD）对小分子物质的清除效果相似，但对中大分子物质的清除明显优于LFHD ，且可以减少关节病变、腕管综合征、心血管系统并发症发生，但应注意低血压等不良反应的发生。
【목적】탐토고통량혈액투석（HFHD）재종말기신장병（ ESRD）환자중적응용개치。【방법】수집혈액투석시간재1년이상적136례ES RD환자적림상자료，근거투석기초려계수적불동분위삼조：초려계수11．3 mL/（h · mmHg）적저통량8LR조（A조）；초려계수50 mL/（h · mmHg）적고통량PS15조（B조）；초려계수71 mL/（h · mmHg）적고통량17R조（C조）。비교삼조혈액투석전후적혈뇨소담（BUN）、기항（SCr）、혈린（P3＋）、혈갑（K＋）、혈청갑상방선격소（iPTH）、β2-미구단백（β2-MG）、혈청백단백（ALB）、수소（LP）、동형반광안산（Hcy）、유생소B12（Vit B12）등지표，병분석비교각조혈액투석후관절병변、완관종합정、심혈관계통등병발증。【결과】삼조혈BUN、SCr、P3＋、K＋등소분자물질비교무현저성차이（ P ＞0．05）；이B、C조iPTH、β2-MG、ALB、LP、Hcy、Vit B12등중대분자물질적청제칙우우A조（ P ＜0．05），차C조대중대분자독소적청제솔최고（P＜0．05）；B、C조관절병변、완관종합정、심혈관계통병발증명현소우A조（P＜0．05），이저혈압병적발생솔고우A조（P ＜0．05），단삼조감염솔、병사솔비교무통계학차이（P ＞0．05）。【결론】HF-HD여저통량혈액투석（LFHD）대소분자물질적청제효과상사，단대중대분자물질적청제명현우우LFHD ，차가이감소관절병변、완관종합정、심혈관계통병발증발생，단응주의저혈압등불량반응적발생。
To explore the application value of high-flux hemodialysis(HFHD) in patients with end-stage renal disease(ESRD) .[Methods]Clinical data of 136 ESRD patients undergoing hemodialysis for more than 1 year were collected .According to ultrafiltration coefficient of dialyzer ,all patients were divided into low-flux[ultrafiltration coefficient was 11 .3 mL/(h · mmHg)] 8LR group(group A) ,high-flux[ultrafil-tration coefficient was 50 mL/(h · mmHg)] PS15 group(group B) and high-flux[ultrafiltration coefficient was 71 mL/(h · mmHg)] 17R group(group C) .Blood urea nitrogen(BUN) ,creatinine ,serum phosphorus and potassium clearance ,serum intact parathyroid hormone(iPTH),β2-microglobulin(β2-MG),serum albumin (ALB) ,leptin ,homocysteine ,vitamin B12 and other indicators were compared among 3 groups .The incidence of complications such as joint disease ,carpal tunnel syndrome and cardiovascular diseases in 3 groups after di-alysis were analyzed and compared .[Results] There was no significant difference in blood BUN ,serum creati-nine ,serum phosphorus ,serum potassium and other small molecular substances among 3 groups( P>0 .05) . The clearance rates of iPTH ,β2-MG ,ALB ,leptin ,homocysteine ,vitamin B12 and other middle or giant mo-lecular substances in group B and group C were better than group A ( P>0 .05) .The clearance rate of middle or giant molecular toxin in group C was the highest( P >0 .05) .The incidence of complications such as joint disease ,carpal tunnel syndrome and cardiovascular disease in group B and C was lower than that in group A ( P<0 .05) ,but the incidence of hypotension in group B and C was higher than that in group A ( P <0 .05) . There was no significant difference in infection rate and mortality among 3 groups( P >0 .05) .[Conclusion]The clearance effect of HFHD on small molecular substances is similar to low-flux hemodialysis(LFHD) ,but its effect on middle or giant molecular substances is obviously better than LFHD ,and can reduce the incidence of joint disease ,carpal tunnel syndrome and cardiovascular disease .But the incidence of adverse reactions such as hypotension should be paid attention .