天津医药

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高通量透析治疗对尿毒症血液透析患者血脂代谢的影响

赵继红   

  1. 天津市三中心医院
  • 收稿日期:2010-01-15 修回日期:2010-05-27 出版日期:2010-08-15 发布日期:2010-08-15
  • 通讯作者: 赵继红

zhao   

  • Received:2010-01-15 Revised:2010-05-27 Published:2010-08-15 Online:2010-08-15
  • Contact: zhao

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摘要： 摘要 目的: 观察高通量血液透析对尿毒症维持性血液透析患者血脂代谢的影响。方法: 将50例终末期肾病血液透析患者随机分为高通量血液透析组(HPD)25例、常规血液透析组(CHD)25例，进行为期1年的研究。分别于入组时、6月、1年后采血测定患者透析前后血浆胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、脂蛋白A(Lpa)以及尿素氮（BUN）、血肌酐（Cr）、Β2微球蛋白（Β2-MG）、血浆白蛋白（ALB）、血红蛋白（Hb）。对比分析2组在透析开始时、透析6月后和透析1年后上述各项指标的变化情况。 结果:2组治疗方式对低分子溶质BUN、Cr清除差异无统计学意义( P>0.05)；高通量透析治疗组血脂、Β2-MG、ALB、Hb指标改善明显优于常规透析组；2组患者透析前的血脂各项指标无差异，治疗后HPD组 TC、TG、LDL逐渐降低，HDL升高；CHD组随透析时间的延长，TC、TG、LDL都呈逐渐升高趋势，其中TG变化最明显(P＜0.01)，而HDL逐渐降低；透析1年后HPD组与CHD组相比TC、TG、LDL和 Lpa明显降低(P ＜0.01)，HDL显著性升高(P ＜0.05)。结论: 常规血液透析对尿毒症患者的血脂紊乱无改善，且有促进作用，高通量透析可以明显改善透析患者的血脂代谢。

关键词: 　高通量透析, 常规血液透析, 血脂代谢

Abstract: Objective To observe the effect of high flux permeable hemodialysis (HPD) and conventional hemodialysis (CHD) on lipid metabolism in patients with maintenance hemodialysis. Methods fifty patients with end stage renal disease were treated with maintenance renal replacement therapy of HPD (n=25), CHD (n=25) for 1 year . Serum lipids, BUN, Cr, Β2-MG, ALB, Hb were measured at the start and the 6 months, 1 year of predialysis and postdialysis of this study. we observed their alterations in serum lipids before the change and after the renal replacement therapy for 1 year. Results The two groups had similar curative effect in the aspect of cleaning micromolecules (BUN, Cr)., and high flux hemodialysis (HPD) were outstripped the conventional hemodialysis (CHD) in the aspect of improving lipid metabolism, Β2-MG and Hb . At the beginning of the treatment, no significant differences in serum lipids were found among the 2 groups. In patients treated with HPD , serum total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL) and apolipoprotein A(Lpa) decreased, and high-density lipoprotein (HDL) increased gradually after the treatment. However, in those treated with CHD, TC, TG, LDL and Lp(a) increased, the increase of TG was most remarkable (P<0.01),HDL decreased gradually after the treatment; When comparisons of serum lipids were made between the 2 groups after the dialysisly for 1 year, TC、TG、LDL and Lpa were lower(P ＜0.01), t and HDL were higher(P ＜0.05) in HPD group than CHD group. Conclusion The derangement of lipid metabolism in uremic patients was aggravated by CHD , but was improved by HPD is effective in improving lipid metabolism in hemodialysis patients.

Key words: High permeable hemodialysis, Conventional hemodialysis, Lipid metabolism