高通量血液透析技术在高龄尿毒症患者中的应用价值研究

    Application value of high flux hemodialysis in uremic elders

    • 摘要: 目的 探讨高通量血液透析(high flux hemodialysis,HFHD)技术在高龄尿毒症患者中应用价值。方法 选取2018年10月至2020年1月邢台市第三医院年龄大于70岁的尿毒症患者102例,依据随机数字表法分为研究组与对照组各51例。常规干预基础上研究组采取HFHD治疗,对照组采取低通量血液透析(low flux hemodialysis,LFHD),均治疗12周。统计两组临床疗效、治疗前及治疗6周、12周后体内毒素相关指标如尿素氮(blood urea nitrogen,BUN)、血清肌酐(serum creatinine,Scr)、硫酸对甲酚(P-cresol sulfate,PCS)、硫酸吲哚酚(indoxyl sulfate,IS)、β2-微球蛋白(β2-microglobulin,β2-MG)、甲状旁腺激素(parathyroid hormone,PTH);中性粒细胞(neutrophils,NE)吞噬功能(吞噬率、吞噬指数);血清炎性因子如C反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)、IL-8水平;钙磷代谢指标如血钙、血磷水平,随访3个月统计两组预后。结果 研究组总有效率(94.12%)高于对照组(80.39%)(P<0.05);治疗6周、12周后两组血清BUN、Scr、PCS、IS、β2-MG、PTH、CRP、TNF-α、IL-6、IL-8、血磷水平较治疗前降低,且研究组低于对照组(P<0.05);治疗6周、12周后两组NE吞噬率、NE吞噬指数较治疗前增高,且研究组高于对照组(P<0.05);治疗后1个月、2个月、3个月研究组病死率与对照组间差异无统计学意义(P>0.05)。结论 采取HFHD技术治疗高龄尿毒症可有效提高治疗效果,可能与其能更有效清理体内毒素、调节血清炎性因子、钙磷代谢指标及NE吞噬功能具有一定关联性。

       

      Abstract: Objective To explore the application value of high flux hemodialysis(HFHD) in uremic elders. Methods From October 2018 to January 2020, a total of 102 uremic elders aged over 70 years were selected and randomized into two groups of study and control(n=51 each). On the basis of routine intervention, study group received 12-week HFHD while control group had 12-week low flux hemodialysis(LFHD). Clinical efficacy, blood urea nitrogen(BUN), serum creatinine(Scr), p-cresol sulfate(PCS), indolyl sulfate(IS) and serum creatinine(Scr) of two groups were statistically analyzed. And β2-microglobulin(β2-mg), parathyroid hormone(PTH), neutrophil(NE) phagocytic function(phagocytic rate/index), serum inflammatory factors such as C-reactive protein(CRP), tumor necrosis factor-α(TNF-α), interleukin-6(IL-6) and interleukin-8(IL-8) were measured. The parameters of calcium and phosphorus metabolism, such as serum calcium(CA) and phosphorus(P), were followed up for 3 months. Results The overall effective rate of study group was higher than that of control group(94. 12% vs 80. 39%) (P<0. 05). At 6 and 12 weeks of treatment, serum BUN, Scr, PCs, IS, β2-MG, PTH, CRP and TNF-α declined and their levels were lower than controls. The levels of IL-6, IL-8 and P were lower in study group than those in control group(P<0. 05);At 6 and 12 weeks of treatment, NE phagocytosis rate/index of two groups were higher than pre-treatment and study group was higher than control group(P<0. 05);no significant inter-group difference existed in mortality at Month 1/2/3 post-treatment(P>0. 05). Conclusion HFHD technology can effectively improve the therapeutic efficacy for uremic elders. It is probably correlated to a more effective removal of toxins, a modulation of serum inflammatory factors, calcium and phosphorus metabolism and NE phagocytosis.

       

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