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目的探讨高通量血液透析(HFD)联合血液灌流(HP)对维持性血液透析(MHD)患者血清成纤维生长因子23(FGF23)、白介素6(IL-6)等中大分子溶质清除以及生活质量改善的影响。方法入选35例MHD患者,每周行3次透析,其中HFD 2次/周,HFD+HP 1次/周,共治疗12个月。每3个月测定血常规、血清白蛋白、血钙、血磷、全段甲状旁腺激素(i PTH)等指标。第0、6、12个月ELISA法测定血清FGF23和IL-6。研究开始和结束时分别使用SF-36量表评价患者生活质量。结果完成12个月随访的患者共33例,平均年龄为(59.06±0.64)岁,平均透析龄(178.94±51.50)个月。与治疗前比较,随访期间患者血红蛋白、血清前白蛋白、血清白蛋白、血钙、血磷、i PTH无显著变化。与治疗前比较,患者FGF23在治疗6个月后显著下降(P=0.046),在治疗12个月后进一步下降(P=0.006)。与治疗前比较,患者IL-6在治疗6个月时显著下降(P=0.015),在治疗12个月时进一步下降(P=0.015)。随访12个月后,MHD患者各项评分均有显著改善(P<0.05)。结论 HFD联合HP治疗可有效清除MHD患者中大分子毒素,是改善MHD患者生活质量的有效治疗方法。
Objective To investigate the effects of high-flux hemodialysis (HFD) combined with hemoperfusion (HP) on the clearance and life span of the solutes of the macromolecules in serum of patients with maintenance hemodialysis (MHD), such as fibroblast growth factor 23 (FGF23), interleukin 6 The impact of quality improvement. Methods Thirty-five patients with MHD were enrolled in this study. The patients underwent dialysis three times per week, including HFD 2 times / week and HFD + HP 1 time / week for a total of 12 months. Every 3 months determination of blood, serum albumin, serum calcium, phosphorus, the whole parathyroid hormone (i PTH) and other indicators. Serum FGF23 and IL-6 were measured by ELISA at 0, 6, and 12 months. At the start and end of the study, patients were assessed for quality of life using the SF-36 scale. Results A total of 33 patients completed the 12-month follow-up. The mean age was 59.06 ± 0.64 years and the mean dialysis age was 178.94 ± 51.50 months. Compared with before treatment, hemoglobin, serum albumin, serum albumin, serum calcium, serum phosphorus, i PTH no significant change during follow-up. Compared with pretreatment, FGF23 decreased significantly (P = 0.046) 6 months after treatment and further decreased 12 months after treatment (P = 0.006). IL-6 decreased significantly (P = 0.015) at 6 months and declined further at 12 months (P = 0.015) compared with pretreatment. After 12 months of follow-up, all the scores of MHD patients were significantly improved (P <0.05). Conclusion HFD combined with HP can effectively remove macromolecular toxins from patients with MHD and is an effective treatment to improve the quality of life in patients with MHD.