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目的探讨血液透析(hemodialysis,HD)联合血液灌流(hemoperfusion,HP)的组合型人工肾以及血液透析滤过(hemodiafiltration,HDF)对维持性血液透析患者内皮素(endothelin-1,ET-1)、瘦素(leptin,LEP)及β2-微球蛋白(β2-microglobulin,β2-MG)的清除效果。方法维持性血液透析患者67例,根据治疗方法分为组合型人工肾组34例和HDF组33例,比较2组单次治疗前、后及规律治疗3个月后血ET-1、LEP及β2-MG的清除率。结果 (1)治疗前,HDF组ET-1、LEP及β2-MG分别为(189.11±12.22)ng/L、(22.87±3.17)μg/L、(51.55±4.12)mg/L,组合型人工肾组分别为(194.67±13.55)ng/L、(24.15±3.84)μg/L、(47.54±3.99)mg/L,2组比较差异无统计学意义(P>0.05);(2)单次治疗后,HDF组ET-1、LEP及β2-MG分别为(184.20±11.98)ng/L、(23.15±2.18)μg/L、(28.76±5.45)mg/L,组合型人工肾组分别为(114.24±12.77)ng/L、(25.01±3.32)μg/L、(38.25±3.11)mg/L,组合型人工肾组ET-1以及HDF组β2-MG与治疗前比较明显降低(P<0.05),2组LEP水平与治疗前比较差异无统计学意义(P>0.05);(3)治疗3个月,HDF组ET-1、LEP及β2-MG分别为(154.25±10.09)ng/L、(19.25±3.22)μg/L、(29.34±4.67)mg/L,组合型人工肾组分别为(106.54±20.48)ng/L、(20.17±4.12)μg/L、(30.92±3.75)mg/L,2组ET-1、β2-MG与治疗前比较差异有统计学意义(P<0.05),LEP与治疗前比较有所下降,但差异无统计学意义(P>0.05);(4)单次治疗后及治疗3个月,2组LEP比较差异均无统计学意义(P>0.05);单次治疗后2组ET-1、β2-MG比较差异有统计学意义(P<0.05);治疗3个月,2组ET-1比较差异有统计学意义(P<0.05),但β2-MG比较差异无统计学意义(P>0.05)。结论组合型人工肾以及HDF均可有效清除ET-1、β2-MG,但组合型人工肾单次及短期治疗对ET-1清除效果优于HDF;HDF单次治疗清除β2-MG效果优于组合型人工肾,而短期治疗2种方法清除效果相近;2种技术短期治疗对LEP清除均有一定作用。
Objective To investigate the effects of hemodialysis combined with hemodialysis (HP) combined with artificial kidney and hemodiafiltration (HDF) on endothelin-1 (ET-1) Scavenging effect of leptin (LEP) and β2-microglobulin (β2-MG). Methods Sixty-seven patients undergoing maintenance hemodialysis were divided into combined artificial kidney group (n = 34) and HDF group (n = 33) according to the method of treatment. The levels of ET-1, LEP and β2-MG clearance rate. Results Before treatment, the ET-1, LEP and β2-MG in HDF group were (189.11 ± 12.22) ng / L, (22.87 ± 3.17) μg / L and 51.55 ± 4.12 mg / (194.67 ± 13.55) ng / L, (24.15 ± 3.84) μg / L and (47.54 ± 3.99) mg / L, respectively. There was no significant difference between the two groups (P> 0.05) After treatment, the levels of ET-1, LEP and β2-MG in HDF group were (184.20 ± 11.98) ng / L and (23.15 ± 2.18) μg / L and (114.24 ± 12.77) ng / L, (25.01 ± 3.32) μg / L and (38.25 ± 3.11) mg / L, respectively. Compared with the pretreatment, ET-1 and HDF in combined AR group were significantly decreased (P < 0.05). The level of ET-1, LEP and β2-MG in HDF group were (154.25 ± 10.09) ng / L, (19.25 ± 3.22) μg / L and (29.34 ± 4.67) mg / L respectively, and the combined artificial kidney group were (106.54 ± 20.48) ng / L and (20.17 ± 4.12) μg / L and (30.92 ± 3.75) mg / L, ET-1 and β2-MG in two groups were significantly different from those before treatment (P <0.05), LEP decreased compared with those before treatment, but the difference was not statistically significant (P> 0.05) 4) After a single treatment and treatment for 3 months, two groups were compared LEP differences (P> 0.05). There was significant difference in the ET-1 and β2-MG between the two groups after single treatment (P <0.05). There was significant difference in the ET-1 between the two groups (P <0.05), but the difference of β2-MG was not statistically significant (P> 0.05). Conclusions The combination of artificial kidney and HDF can effectively remove ET-1 and β2-MG, but the single and short-term combination therapy of artificial kidney is superior to HDF in removing ET-1; Combination of artificial kidney, and short-term treatment of two clear clearance effect is similar; 2 kinds of short-term treatment of LEP have a role in the removal.