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目的探讨长期间歇性高效on-line血液透析滤过(HDF)对维持性血液透析(MHD)患者营养状况的影响。方法回顾性分析2004年1月至2011年2月楚雄彝族自治州人民医院肾脏内科血液净化中心收治的透析龄超过5年、资料完整的112例MHD患者的治疗资料,按不同透析方式将患者分为长期间歇性高效HDF组(60例)和常规血液透析(HD)组(52例),评估长期间歇性高效HDF对MHD患者营养状况的影响,并对影响主观综合营养评估(SGA)的因素进行分析。结果治疗12、36、60个月后,长期间歇性高效HDF组患者清蛋白(ALB)水平和SGA评分均明显优于同期常规HD组,差异均有统计学意义(P<0.05)。尿素清除指数(Kt/V)、β2微球蛋白(β2-MG)、C反应蛋白(CRP)、ALB、碳酸氢盐(HCO3-)是影响长期MHD患者SGA的独立因素,其中Kt/V、ALB和HCO3-为正性影响因子,β2-MG、CRP为负性影响因子。结论长期间歇性高效on-line HDF治疗通过进一步提高充分透析性、更好地纠正酸中毒和减轻体内炎症状态,以及维持较高的血清ALB水平,可持续显著改善MHD患者的营养状况,且效果优于单纯HD治疗。
Objective To investigate the effect of long-term intermittent high-efficiency on-line hemodiafiltration (HDF) on the nutritional status of maintenance hemodialysis (MHD) patients. Methods Retrospective analysis of the treatment data of 112 MHD patients with dialysis age more than 5 years and complete data from January 2004 to February 2011 in Renal Medical Center of Chuxiong Yi People’s Hospital were divided into Long-term intermittent high-efficiency HDF group (60 cases) and conventional hemodialysis group (52 cases), to assess the impact of long-term intermittent high-efficiency HDF on nutritional status of MHD patients, and factors affecting subjective comprehensive nutritional assessment (SGA) analysis. Results After 12, 36 and 60 months of treatment, the level of albumin (ALB) and SGA in long-term intermittent high-efficiency HDF group were significantly better than those in routine HD group (P <0.05). Kt / V, β2-MG, CRP, ALB and bicarbonate (HCO3-) were the independent factors influencing SGA in long-term MHD patients. Kt / V, ALB and HCO3- positive factors, β2-MG, CRP negative factors. Conclusion Long-term, intermittent, and efficacious on-line HDF treatment can significantly and sustainably improve the nutritional status of patients with MHD by further improving adequate dialysis, better correcting acidosis and reducing inflammation in vivo, and maintaining high serum ALB levels Better than simple HD treatment.