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目的观察组合型人工肾对尿毒症中分子毒素清除的疗效。方法选择维持性血液透析患者57例,采用随机数字表及随机数余数分组法随机分为组合型人工肾(HD+HP)组、血液透析滤过(HDF)组及血液透析(HD)组3组。检测首次透析前后及透析第4、8周后患者血β2微球蛋白(β2-MG)及全段甲状旁腺素(iPTH),8周后观察对患者皮肤瘙痒症的疗效,并对各组指标进行统计分析。结果 HD+HP组首次透析前后患者的β2-MG、iPTH均明显下降(均P<0.05),透析4、8周后与首次透析前相比,患者的β2-MG、iPTH均显著下降(均P<0.01);HDF组首次透析前后的β2-MG、iPTH差异均无统计学意义(均P>0.05),透析4、8周后β2-MG、iPTH明显下降(P<0.05);HD组首次透析前后及透析4、8周后的β2-MG、iPTH差异均无统计学意义(均P>0.05)。8周后,皮肤瘙痒症临床有效率HD+HP组最高,达89.47%,HDF组57.89%,HD组15.79%。结论 HD+HP能有效地清除尿毒症患者的中分子毒素,明显缓解皮肤瘙痒症状,其效果优于HDF,HDF治疗无效者改用HD+HP治疗可能有效,而HD不能清除尿毒症的中分子毒素。
Objective To observe the effect of combined artificial kidney on detoxification of molecular toxins in uremia. Methods Fifty-seven patients with maintenance hemodialysis were randomly divided into HD + HP group, HDF group and HD group 3 with random number table and random number grouping method group. The levels of β2-microglobulin (β2-MG) and whole-blood parathyroid hormone (iPTH) were measured before and after dialysis for 4 and 8 weeks. The curative effect on pruritus in patients was observed after 8 and 8 weeks. Indicators for statistical analysis. Results The levels of β2-MG and iPTH in HD + HP group decreased significantly (all P <0.05) before and after the first dialysis, and the levels of β2-MG and iPTH in HD + HP group were significantly lower than those before dialysis for 4 and 8 weeks P <0.01). There was no significant difference of β2-MG and iPTH between the HDF group and the HDF group (P> 0.05) There was no significant difference in β2-MG and iPTH before and after dialysis for 4 and 8 weeks (all P> 0.05). Eight weeks later, the pruritus clinically effective HD + HP group was the highest, reaching 89.47%, HDF group 57.89%, HD group 15.79%. Conclusion HD + HP can effectively remove the molecular toxins in patients with uremia, significantly relieve pruritus symptoms, the effect is better than HDF, HDF treatment ineffective use of HD + HP treatment may be effective, and HD can not clear uremic middle molecules toxin.