不同血液净化方式对尿毒症患者贫血的影响

摘要

目的：探讨不同血液净化方式对维持性血液透析患者贫血的影响。方法：选取2010年1月至2012年12月在我院维持性血液透析的患者60例并随机分成三组： HD组20例，HP＋HD组23例， HDF＋HD17例；观察三组患者治疗6个月前后血色素变化；并对三组患者治疗前后血β2-MG、iPTH、CRP、ALB 、KT/V、 EPO用量等相关因素进行分析。结果：治疗后三组患者血色素明显提高，与治疗前相比差异显著（P＜0．05）。 HP＋HD、HD＋HDF组治疗后血素色提高更明显，与HD组相比较差异显著（ P＜0．05）， HP＋HD与HD＋HDF两组间比较差异无统计学意义。 HP＋HD与HD＋HDF两组患者β2-MG、iPTH、CRP治疗后明显降低，较治疗前差别有统计学意义（P＜0．05），两组间上述指标下降幅度比较差异无统计学意义（ P＞0．05）。单纯HD组患者β2-MG、iPTH、CRP 治疗前后差别无统计学意义（ P＞0．05）。三组患者治疗前后KT/V、ALB无明显差异（ P＞0．05）；三组患者在观察结束时EPO用量均有所减少，但三组间以及与入组时相比差别无统计学意义（ P＞0．05）。结论：HP＋HD及HD＋HDF能更好改善维持性血液透析患者贫血状态，其机制可能与二者有效的清除维持性血液透析患者体内的大、中分子毒素有关。%Objective:To investigate the influence of afferent blood purification methods on anemia of uremic patients .Method: A total of 60 patients on maintenance hemodialysis treated in our hospital from Jaunary 2010 to December 2012 were recruited .They were randomly assigned into 3 groups: hemodialysis group (HD) (n=20),hemodiafihration +hemodialysis group (HD+HDF) (n=17),and hemoperfusion +hemodialysis group ( HD+HP ) ( n=23 ) .Blood samples were taken for the assays of serum anemia before and after the treatment .The change of hemoglobin have been observed major for the patients in three groups after 6 months treatment.At the same time , the related factors have been analysed about β2-MG,iPTH, CRP,ALB ,KT/V,EPO etc.Result:After the treatment for 6 months ,Hemoglobin of the three groups was improved, there was significant difference than before treatment (P<0.05), Hemoglobin was improved more distinct in HD+HP and HD+HDF groups , there was significant difference compared with HD group ( P<0. 05).But there was no difference between HD+HP and HD+HDF.β2-MG,iPTH and CRP was lower in HD+HP and HD+HDF groups than those in HD groups .KT/V and ALB were no change in three groups prethera-py and post-treatment(P>0.05).Dosage of erythropoiebin were less before treatment than post treatment , but there was no remarkable difference in three groups patients (P>0.05).Conclusion: HD+HP and HD+HDF could had better effect than the HD group on improving effectively anemia ,It is probably relating to the clear-ance of β2-MG,iPTH and CRP etc .