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目的探讨血液灌流(HP)联合血液透析(HD)对维持性血液透析(MHD)患者血中大分子毒素的清除及其营养状态的影响。方法将90例MHD患者随机分为2组,各45例,分别采用HP联合HD(HP+HD组)、单纯HD(HD组)进行血液净化,2组均给予营养干预及基础治疗6个月;对比分析治疗前后2组大分子毒素及营养相关指标的变化。结果治疗后,2组PTH、β_2-MG、LEP水平均明显低于治疗前,差异均有统计学意义(P<0.05),且HP+HD组PTH[(52.18±4.27)μg/L]、β_2-MG[(15.22±2.06)mg/L]、LEP[(21.70±5.15)μg/L]水平均明显比HD组更低,差异均有统计学意义(P<0.05)。HP+HD组治疗后ALB[(41.29±4.56)g/L]、Hb[(102.33±12.80)g/L]、TF[(3.29±0.74)g/L]水平及BMI[(23.68±2.03)kg/m2]、MAC[(25.10±1.86)cm]、MAMC[(21.08±2.30)cm]、TSF[(17.14±3.82)mm]均明显高于治疗前及HD组,差异均有统计学意义(P<0.05)。结论在合理的营养干预下,HP联合HD对MHD患者血中大分子毒素的清除作用及营养状态的改善作用明显优于单纯HD治疗。
Objective To investigate the effects of hemoperfusion (HP) and hemodialysis (HD) on the clearance of macromolecular toxins and their nutritional status in patients with maintenance hemodialysis (MHD). Methods Ninety patients with MHD were randomly divided into two groups (n = 45 each). The blood was purified by HP combined with HD (HD + HD group) and HD alone (HD group). Both groups were given nutritional intervention and basic treatment for 6 months ; Comparative analysis of two groups of macromolecular toxins and nutritional indicators before and after treatment changes. Results After treatment, the levels of PTH, β_2-MG and LEP in two groups were significantly lower than those before treatment (P <0.05), and PTH in HP + HD group was (52.18 ± 4.27) μg / L, The levels of β_2-MG [(15.22 ± 2.06) mg / L] and LEP [(21.70 ± 5.15) μg / L] were significantly lower than those of HD group, with statistical significance (P <0.05). The levels of ALB and BMI in the HP + HD group after treatment were significantly higher than those in the control group (41.29 ± 4.56 g / L vs 102.33 ± 12.80 g / L, TF [3.29 ± 0.74 g / L] (25.10 ± 1.86) cm, MAMC (21.08 ± 2.30) cm and TSF (17.14 ± 3.82) mm were significantly higher than those before treatment and HD group, the differences were statistically significant (P <0.05). Conclusions Under proper nutrition intervention, HP combined with HD can significantly improve the clearance of macromolecular toxins and the nutritional status in patients with MHD.