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目的探讨高通量血液透析(high permeable hemodialysis,HPD)对维持性血液透析(maintenance hemodialysis,MHD)患者颈动脉粥样硬化的影响及机制。方法维持性血液透析的患者60例,高通量透析组(HPD组)和普通透析组(LPD组)各30例。HPD组采用费森尤斯公司FX60高通量透析器,LPD组采用费森尤斯公司F7透析器。两组患者每周透析时间均为12 h。治疗时间6个月,观察两组患者治疗前后血压、血脂、甲状旁腺激素(parathyroid hormone,PTH)及钙磷乘积、颈总动脉内膜-中层厚度(intima medial thickness,IMT)。结果治疗6个月后,LPD组收缩压、平均动脉压、三酰甘油、钙磷乘积和PTH指标与透析前相比差异无统计学意义(P>0.05)。与LPD组相比,HPD组收缩压和平均动脉压明显降低,三酰甘油水平和IMT值低于LPD组(P<0.05),颈总动脉IMT低于LDP组(P<0.05),但两组患者钙磷乘积和PTH差异无统计学意义(P>0.05)。结论高通量透析模式可以延缓维持性血液透析患者颈动脉粥样硬化进展,其对血压和血脂的影响可能是其中机制。
Objective To investigate the effect of high permeable hemodialysis (HPD) on carotid atherosclerosis in patients with maintenance hemodialysis (MHD). Methods Sixty patients with maintenance hemodialysis, 30 patients in high-throughput dialysis group (HPD group) and 30 patients in general dialysis group (LPD group). HPD group using Freescale FX60 high-throughput dialyzer, LPD group Fresenius F7 dialyzer. The two groups of patients per week dialysis time was 12 h. The treatment time was 6 months. The blood pressure, blood lipid, parathyroid hormone (PTH) and calcium-phosphorus product, carotid artery intima-medial thickness (IMT) were observed before and after treatment. Results After 6 months of treatment, the systolic blood pressure, mean arterial pressure, triglyceride, calcium-phosphorus product and PTH in LPD group were not significantly different from those before dialysis (P> 0.05). Compared with LPD group, systolic blood pressure and mean arterial pressure were significantly decreased, triglyceride level and IMT were lower in HPD group than those in LPD group (P <0.05), and common carotid artery IMT was lower than LDP group (P <0.05) There was no significant difference in calcium and phosphorus products and PTH between groups (P> 0.05). Conclusion High-throughput dialysis mode can delay the progression of carotid atherosclerosis in maintenance hemodialysis patients, and its effect on blood pressure and blood lipid may be one of the mechanisms.