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目的分析不同血液净化方式对维持性血液透析患者血清中分子毒素的清除效果。方法 30例慢性肾功能衰竭维持性血液透析患者,随机分成A组(9例),B组(11例)和C组(10例)。A组采用血液透析(HD)治疗,B组采用血液灌流(HP)+血液透析(HD)治疗,C组采用透析滤过治疗(HDF)。治疗前后测定甲状旁腺素(PTH)、β_2-微球蛋白(β_2-MG),观察治疗12周后三组患者皮肤瘙痒、关节疼痛、失眠改善程度。结果治疗12周后B组和c组血清PTH、β_2-MG水平较治疗前明显下降,差异有统计学意义(P<0.05)。治疗12周后B组和C组患者皮肤瘙痒、骨关节疼痛及失眠症状改善总有效率高于A组,差异有统计学意义(P<0.05)。治疗1 2周后B组患者皮肤瘙痒、骨关节疼痛及失眠症状改善总有效率分别为72.7%、63.6%、72.7%,与C组的80.0%、70.0%、80.0%,差异无统计学意义(P>0.05)。结论血液透析滤过和灌流联合血液透析对防止尿毒症患者近期与远期并发症具有重要作用。
Objective To analyze the effect of different blood purification methods on the clearance of molecular toxins in serum of maintenance hemodialysis patients. Methods Thirty patients with maintenance hemodialysis of chronic renal failure were randomly divided into group A (n = 9), group B (n = 11) and group C (n = 10). Group A was treated by hemodialysis (HD), Group B by hemoperfusion (HP) and hemodialysis (HD), and Group C by hemodiafiltration (HDF). Before and after treatment, parathyroid hormone (PTH) and β_2-microglobulin (β_2-MG) were measured. Skin pruritus, joint pain and insomnia were observed in three groups after 12 weeks of treatment. Results After 12 weeks of treatment, the levels of PTH and β_2-MG in group B and c were significantly lower than those before treatment (P <0.05). After 12 weeks of treatment, the total effective rate of skin pruritus, joint pain and insomnia improvement in group B and group C were higher than that in group A, the difference was statistically significant (P <0.05). The total effective rates of pruritus, joint pain and insomnia in group B after treatment for 12 weeks were 72.7%, 63.6% and 72.7% respectively, which were not significantly different from those in group C 80.0%, 70.0% and 80.0% (P> 0.05). Conclusion Hemodiafiltration and perfusion combined with hemodialysis plays an important role in preventing the short-term and long-term complications of patients with uremia.