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目的研究不同血液净化方式对维持性血液透析(MHD)患者生活质量的影响。方法选取134例MHD患者,随机分为血液透析组(A组,47例)、血液灌流+血液透析组(B组,43例)、血液透析滤过组(C组,44例),检测不同时期甲状旁腺激素(PTH)及β_2微球蛋白(β_2-MG)水平。随访观察24个月,采用肾脏病生活质量简表(KDQOL-SFTM1.3)评价三组患者生活质量。结果随访观察12、18、24个月时,B、C组PTH值、β_2-MG水平均低于A组(P<0.01或P<0.05),B组β_2-MG水平高于C组(P<0.01)。随访观察24个月,B、C组患者的肾脏病与透析相关生存质量(KDTA)总分及分支领域(肾病影响、工作状况、睡眠、患者满意度、性功能、自我健康评价)得分、一般健康相关生存质量(SF-36)总分及分支领域(躯体功能、躯体职能、社会功能、心理健康、躯体疼痛、精力状况、总体健康期望)得分、生存率均高于A组(P<0.01或P<0.05),B、C组间各指标差异均无统计学意义(P>0.05)。结论血液透析滤过、血液灌流+血液透析较血液透析更能有效地清除MHD患者体内PTH和β_2-MG,能更好地改善患者的生存质量,提高患者生存率。
Objective To study the effect of different blood purification methods on quality of life in maintenance hemodialysis (MHD) patients. Methods One hundred and thirty-four patients with MHD were randomly divided into hemodialysis group (n = 47), hemoperfusion + hemodialysis group (n = 43), hemodiafiltration group (n = 44) (PTH) and β_2-microglobulin (β_2-MG) levels during the period. The patients were followed up for 24 months. The quality of life of the three groups was evaluated by KDQOL-SFTM1.3. Results The levels of PTH and β_2-MG in group B and C were significantly lower than those in group A (P <0.01 or P <0.05) at 12, 18 and 24 months after follow-up. The level of β_2-MG in group B was higher than that in group C <0.01). The 24-month follow-up was performed. The scores of kidney disease, dialysis-related quality of life (KDTA), and the score in the branch areas (nephropathies, working conditions, sleep, patient satisfaction, sexual function, self-health evaluation) The score and survival rate of health-related quality of life (SF-36) score and branch field (body function, body function, social function, mental health, somatic pain, energy status and overall health expectation) Or P <0.05). There was no significant difference between B and C groups (P> 0.05). Conclusion Hemodialysis, hemoperfusion and hemodialysis are more effective than hemodialysis in removing PTH and β_2-MG in patients with MHD, which can better improve the quality of life and improve the survival rate of patients.