CAJ | 학술논문

目的：比较高通量血液透析（HFHD）及常规血液透析（HD）治疗慢性肾功能衰竭尿毒症期的临床疗效。方法2012年6月—2013年6月收治的慢性肾功能衰竭尿毒症期患者88例，按随机数字表法分为HFHD组与HD组，每组44例。比较2种透析方式的临床疗效，观察血尿素氮（BUN）、血肌酐（SCr）、尿素清除指数（KT／V）、β2-微球蛋白（β2-MG）、血红蛋白（ Hb）、白蛋白（ Alb）、血磷（ P）、血钙（ Ca）及血红蛋白（ Hb）、白蛋白（ Alb）甲状旁腺素（iPTH）等各项指标在透析前后变化，并观察2组的不良反应。结果治疗3个月后，HFHD组患者治疗总有效率为95．5％（42／44），明显高于HD组的68．2％（30／44），差异具有统计学意义（χ2＝9．517， P ＜0．05）。治疗前2组患者间血BUN、SCr、和β2-MG、KT／V比较，差异无统计学意义（ P ＞0．05）；治疗3个月后，2组患者的BUN、SCr、β2-MG、KT／V较治疗前均有明显改善（ t HFHD ＝3．66、2．34、2．45、3．86；t HD ＝2．40、4．57、3．22、2．95， P ＜0．05），且HFHD组中β2-MG、KT／V改善幅度优于HD组（ t ＝5．05、3．92， P ＜0．01）；2组患者的Hb、Alb、iPTH、Ca、P较治疗前均有明显改善（ t HFHD ＝5．88、2．41、3．81、3．21、6．66；t HD ＝2．94、3．32、2．81、4．11、2．40， P均＜0．05），且治疗后HFHD组、iPTH、P均低于HD组（ t ＝7．09、2．39， P ＜0．05），Hb、Alb均高于HD组（ t ＝4．16、3．91， P ＜0．01）。 HFHD组皮肤瘙痒发生率较HD组低（34．1％vs．56．8％，χ2＝4．583， P ＝0．032），其他透析相关并发症的发生率差异无统计意义（ P ＞0．05）。结论高通量血液透析治疗尿毒症期患者的临床疗效优于常规血液透析，且未见明显不良反应。
목적：비교고통량혈액투석（HFHD）급상규혈액투석（HD）치료만성신공능쇠갈뇨독증기적림상료효。방법2012년6월—2013년6월수치적만성신공능쇠갈뇨독증기환자88례，안수궤수자표법분위HFHD조여HD조，매조44례。비교2충투석방식적림상료효，관찰혈뇨소담（BUN）、혈기항（SCr）、뇨소청제지수（KT／V）、β2-미구단백（β2-MG）、혈홍단백（ Hb）、백단백（ Alb）、혈린（ P）、혈개（ Ca）급혈홍단백（ Hb）、백단백（ Alb）갑상방선소（iPTH）등각항지표재투석전후변화，병관찰2조적불량반응。결과치료3개월후，HFHD조환자치료총유효솔위95．5％（42／44），명현고우HD조적68．2％（30／44），차이구유통계학의의（χ2＝9．517， P ＜0．05）。치료전2조환자간혈BUN、SCr、화β2-MG、KT／V비교，차이무통계학의의（ P ＞0．05）；치료3개월후，2조환자적BUN、SCr、β2-MG、KT／V교치료전균유명현개선（ t HFHD ＝3．66、2．34、2．45、3．86；t HD ＝2．40、4．57、3．22、2．95， P ＜0．05），차HFHD조중β2-MG、KT／V개선폭도우우HD조（ t ＝5．05、3．92， P ＜0．01）；2조환자적Hb、Alb、iPTH、Ca、P교치료전균유명현개선（ t HFHD ＝5．88、2．41、3．81、3．21、6．66；t HD ＝2．94、3．32、2．81、4．11、2．40， P균＜0．05），차치료후HFHD조、iPTH、P균저우HD조（ t ＝7．09、2．39， P ＜0．05），Hb、Alb균고우HD조（ t ＝4．16、3．91， P ＜0．01）。 HFHD조피부소양발생솔교HD조저（34．1％vs．56．8％，χ2＝4．583， P ＝0．032），기타투석상관병발증적발생솔차이무통계의의（ P ＞0．05）。결론고통량혈액투석치료뇨독증기환자적림상료효우우상규혈액투석，차미견명현불량반응。
Objective To compare the clinical efficacy of high flux hemodialysis ( HFHD) and conventional hemodi-alysis (HD) treatment for chronic renal failure and uremia .Methods From June 2012 to June 2013, 88 patients with chronic renal failure and uremia were randomly divided into HFHD group and HD group , each group with 44 cases.The two kinds of dialysis modality’s clinical efficacy were compared, blood urea nitrogen (BUN), serum creatinine (SCr), urea clearance in-dex (KT/V),β2 microglobulin (β2-MG), hemoglobin (Hb), albumin (Alb), phosphorus (P), calcium (Ca) and hemo-globin ( Hb) , albumin ( Alb) ,parathyroid hormone ( iPTH) and other indicators before and after the dialysis were compared , and adverse reactions in the two groups were observed .Results After 3 months of treatment , HFHD patients’ total effective rate was 95.5%(42/44), which was significantly higher than the 68.2%of HD group (30/44), the difference was statisti-cally significant (χ2 =9.517, P <0.05).Before treatment, the difference of serum BUN, SCr, and β2-MG, KT /V be-tween the two groups did not show statistically significant ( P >0.05);after treated for three months, the two groups’ BUN, SCr,β2-MG, KT/V were significantly improved compared with before treatment ( HFHD group:t =3.66, t =2.34, t =2.45, t =3.86;HD htoup:t =2.40, t =4.57, t =3.22, t =2.95, P <0.05), and the improvement of β2-MG, KT /V in HFHD group were better than HD group ( t =5.05, t =3.92, P <0.01);2 groups’ Hb, Alb, iPTH, Ca,P were signifi-cantly improved compared with before treatment ( HFHD group:t =5.88, t =2.41, t =3.81, t =3.21, t =6.66; HD group:t =2.94, t =3.32, t =2.81, t =4.11, t =2.40, P <0.05), after treatment, HFHD group’s P and iPTH were low-er than HD group ( t =7.09, t =2.39, P <0.05), Hb, Alb were higher than HD group ( t =4.16, t =3.91, P <0.01). HFHD group’s pruritus incidence was lower than the HD group (34.1%vs.56.8%,χ2 =4.583, P =0.032), the inci-dence of other dialysis-related complications did not show statistically significant differences ( P >0.05).Conclusion High flux hemodialysis uremia ’ s clinical efficacy is better than conventional hemodialysis , especially in clearing large , middle molecular toxins , and with no significant adverse reactions .