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目的:比较高通量血液透析(high flux hemodialysis,HFHD)与其序贯结合不同频率血液透析滤过的疗效。方法:将52例经HFHD治疗半年以上终末期肾病患者随机分为3组,分别为HFHD组(17例)、序贯1组(17例)和序贯2组(18例)。HFHD组继续每周3次HFHD;序贯1组:2周5次HFHD结合2周1次血液透析滤过(hemodiafiltration,HDF);序贯2组:1周2次HFHD结合1周1次HDF;每次透析时间均为4 h。观察并记录3组治疗6个月和12个月时的血压、营养、贫血、透析充分性指标及相关并发症等。结果:3组干预前i PTH、尿素氮、血肌酐、尿素清除率、单室尿素清除指数、干体重指数、血红蛋白及促红素用量间差异无统计学意义(P>0.05)。与HFHD组相比,观察6个月时,序贯2组血浆白蛋白偏低,β2-MG清除率增加(P<0.05);观察12个月时序贯1、2组间血浆白蛋白偏低、β2-MG清除率增加及收缩压明显下降(均P<0.05),序贯2组β2-MG清除率最高。结论:HFHD序贯结合HDF较HFHD易丢失更多的营养成分,但对β2-MG清除及收缩压的控制更好,对透析充分性、提高促红素反应性方面无优势。
Objective: To compare the efficacy of high-flux hemodialysis (HFHD) with its sequential combination of hemodiafiltration at different frequencies. Methods: Fifty-two patients with end-stage renal disease over half a year after HFHD were randomly divided into three groups: HFHD group (17 cases), sequential group 1 (17 cases) and sequential group 2 (18 cases). HFHD group continued HFHD three times a week; Sequential group 1: HFHD combined with two times a week hemodialfiltration (HDF) 5 times in two weeks; Sequential two groups: HFHD combined with once a week HDF once a week ; Each dialysis time is 4 h. The blood pressure, nutrition, anemia, dialysis adequacy index and related complications of the three groups were observed and recorded at 6 and 12 months after treatment. Results: There were no significant differences in i PTH, urea nitrogen, serum creatinine, urea clearance, single compartment urea clearance index, dry weight index, hemoglobin and erythropoietin dosage before intervention in the three groups (P> 0.05). Compared with HFHD group, the plasma albumin was lower and the clearance rate of β2-MG was increased (P <0.05) at 6 months after sequential observation. The plasma albumin was lower in sequential group 1 and 2 at 12 months , Β2-MG clearance increased significantly and systolic blood pressure decreased significantly (both P <0.05). The clearance rate of β2-MG in sequential 2 groups was the highest. CONCLUSION: HFHD is more likely to lose more nutrients than HFHD after HDF, but it has better control of β2-MG clearance and systolic blood pressure, and has no advantage on dialysis adequacy and erythropoietin reactivity.