本文選題：高通量血液透析　切入點(diǎn)：毒素清除　出處：《安徽醫(yī)科大學(xué)》2014年博士論文　論文類型：學(xué)位論文

【摘要】：第一部分高通量血液透析對尿毒癥患者毒素清除、貧血、繼發(fā)性甲旁亢、鈣磷代謝、ET-1、NO、平均動(dòng)脈壓的影響目的:本研究旨在觀察高通量血液透析和常規(guī)低通量血液透析對維持性血液透析患者毒素清除、貧血、繼發(fā)性甲旁亢、鈣磷代謝、ET-1、NO、平均動(dòng)脈壓的影響。對于尿毒癥患者而言,體內(nèi)各種大小不同的毒素分子對其生存質(zhì)量具有重要影響。從這個(gè)角度出發(fā),如何有效清除尿毒癥患者體內(nèi)的中、大分子具有重要的臨床意義。目前,許多臨床資料表明,高通量血液透析能夠更好的清除尿毒癥患者體內(nèi)的大、中分子。但是,現(xiàn)在還沒有足夠的數(shù)據(jù)表明,這種對大、中分子的清除能夠有效的改善尿毒癥患者的一些并發(fā)癥。因此,針對這一個(gè)問題,本部分主要從以下幾個(gè)方面進(jìn)行探討,即高通量血液透析對毒素清除、貧血、繼發(fā)性甲旁亢、鈣磷代謝、ET-1、NO、平均動(dòng)脈壓的作用。方法:本文主要選取了安徽醫(yī)科大學(xué)第三附屬醫(yī)院在2011年10月到2012年6月間進(jìn)行尿毒癥透析治療的42例患者,并將21例隨機(jī)分配到低通量血液透析組、另外21例分配到高通量血液透析組。另外,我們還選取了24例健康的正常對照組。高通量血液透析組患者使用聚砜膜透析器Fx60,而低通量血液透析組使用F7。所有患者每周透析三次,每次4-4.5個(gè)小時(shí),并且透析時(shí)間均超過三個(gè)月,病情穩(wěn)定。并且在透析過程中,尿毒癥患者沒有接受過輸血或免疫抑制劑治療,無外傷手術(shù)。我們分別抽取了高通量血液透析組和低通量血液透析組患者單次透析前后血樣本,每次抽取5 ml。另外,我們還抽取了健康人群空腹血標(biāo)本。然后,我們將這些抽取的血標(biāo)本至于-80~-20oC進(jìn)行保存。將以上血液標(biāo)本進(jìn)行離心后,我們分析了高通量血液透析組患者和低通量血液透析組患者體內(nèi)的血清尿素(BUN)、血磷(P3+)、甲狀旁腺素(intact parathyroid hormone,i PIH)、β2-微球蛋白(β2-microglobulin,β2-MG)水平,進(jìn)而探討高通量血液透析對毒素清除的影響。另外,我們還比較了HFHD和LFHD患者體內(nèi)的血紅蛋白(Hb)、紅細(xì)胞壓積(Hct)、血清白蛋白(ALB)、血肌酐(Scr)水平,進(jìn)而反應(yīng)其對貧血的改善作用。根據(jù)血液內(nèi)甲狀旁腺激素、鈣、磷的變化水平,我們探討了高通量血液透析對繼發(fā)性甲旁亢、鈣磷代謝的影響。而且,我們還比較了高通量血液透析后患者ET-1、Ang II、NO及平均動(dòng)脈壓變化的情況。結(jié)果1.經(jīng)過高通量血液透析以后,患者體內(nèi)的BUN、Scr、血磷、β2-MG下降水平明顯,因此,與常規(guī)的低通量血液透析相比,單次的高通量血液透析不僅表現(xiàn)出類似的對小分子物質(zhì)清除率,而且能夠更好的清除P3+、i PTH、β2-MG等大、中分子,差異具有明顯的統(tǒng)計(jì)學(xué)意義(P均0.05)。2.高通量血液透析6個(gè)月以后,患者體內(nèi)的血紅蛋白(Hb)、紅細(xì)胞壓積(Hct)明顯高于常規(guī)透析組(P均0.05)。3.高通量血液透析6個(gè)月以后,患者體內(nèi)的血磷、甲狀旁腺激素明顯下降。相較于低通量血液透析,我們的數(shù)據(jù)表明高通量血液透析能夠更加有效的清除血液中的甲狀旁腺激素。而且,清除效果與常規(guī)低通量血液透析相比具有明顯的統(tǒng)計(jì)學(xué)差異(P0.05)。4.高通量血液透析6個(gè)月以后,患者體內(nèi)的內(nèi)皮素-1的水平明顯下降并能夠升高血液中NO的水平(P0.05)。結(jié)論1.高通量血液透析可以更好的清除P3+、i PTH、β2-MG。2.高通量血液透析可以使尿毒癥患者的貧血狀況得到明顯改善。3.高通量血液透析能夠使尿毒癥患者繼發(fā)性甲狀旁腺機(jī)能亢進(jìn)得到控制。4.高通量血液透析可以使血液透析患者血液中的內(nèi)皮素、NO等分子能夠得到有效調(diào)節(jié),進(jìn)而改善血管內(nèi)皮細(xì)胞功能,從而有利于患者血壓的控制。第二部分高通量血液透析對尿毒癥患者營養(yǎng)不良、微炎癥以及肺功能、生活質(zhì)量評分的影響目的:本研究旨在觀察高通量血液透析和常規(guī)低通量血液透析對維持性血液透析患者營養(yǎng)不良、炎癥以及肺功能、生活質(zhì)量評分的影響。與常規(guī)低通量血液透析相比,高通量血液透析可以通過彌散、對流和吸附等方法,有效促進(jìn)大、中分子的清除。但是,現(xiàn)在還沒有足夠的數(shù)據(jù)表明,這種對大、中分子的清除能夠有效的改善尿毒癥患者的一些遠(yuǎn)期并發(fā)癥。因此,針對這一個(gè)問題,本部分主要從以下幾個(gè)方面進(jìn)行探討,即高通量血液透析對營養(yǎng)不良、炎癥以及肺功能、生活質(zhì)量評分的影響。方法:本文主要選取了安徽醫(yī)科大學(xué)第三附屬醫(yī)院在2011年10月到2012年6月間進(jìn)行尿毒癥透析治療的42例患者,并將21例隨機(jī)分配到低通量血液透析組、另外21例分配到高通量血液透析組。另外,我們還選取了24例健康的正常對照組。高通量血液透析組患者使用聚砜膜透析器Fx60,而低通量血液透析組使用F7。所有患者每周透析三次,每次4-4.5個(gè)小時(shí),并且透析時(shí)間均超過三個(gè)月,病情穩(wěn)定。并且在透析過程中,尿毒癥患者沒有接受過輸血或免疫抑制劑治療,無外傷手術(shù)。我們分別抽取了高通量血液透析組和低通量血液透析組患者單次透析前后血樣本,每次抽取5 ml。另外,我們還抽取了健康人群空腹血標(biāo)本。然后,我們將這些抽取的血標(biāo)本至于-80~-20oC進(jìn)行保存。將以上血液標(biāo)本進(jìn)行離心后,測定體內(nèi)血清白蛋白(ALB)、血脂、C-反應(yīng)蛋白(CRP)、白介素-6(IL-6)等的濃度,同時(shí),通過測定SGA、TSF、MAC、MAMC來探討高通量血液透析對于改善透析患者營養(yǎng)不良、微炎癥反應(yīng)的作用。此外,由于肺臟是尿毒癥最常受累的臟器之一,尿毒癥患者肺功能可能會受到多方面的影響。我們通過對比低通量血液透析患者和高通量血液透析患者的的肺功能情況,從而探討尿毒癥患者肺功能損害特征及高通量透析治療對其肺功能的影響。為了探討高通量透析對尿毒癥患者生活質(zhì)量的影響,我們用SF-36量表評估了患者的生存質(zhì)量。結(jié)果1.高通量血液透析6個(gè)月以后,患者體內(nèi)的血清白蛋白、HDL、TSF、MAMC水平升高(P0.05),而CHOL、TG、LDL水平下降(P0.05)。而且,透析6個(gè)月后,患者體內(nèi)的IL-6水平明顯下降(P0.05)。2.高通量血液透析3個(gè)月以后,患者的肺功能狀態(tài)得到了一定程度的改善。觀察組和對照組的FVC、MBC、FEV1、FEF、MMEF、V25、DLCO均明顯低于正常組(P0.05)。與治療前相比,治療后觀察組和對照組的FEV1、PEF、MMEF、V25均明顯升高(P0.05),而FVC、MBC、DLco均無明顯變化(P0.05)。同時(shí)觀察組的FEV1、PEF、MMEF、V25變化幅度大于對照組(P0.05),而FVC、MBC、DLco組間差異沒有顯著性(P0.05)。3.高通量血液透析6個(gè)月以后,生活質(zhì)量調(diào)查PCS、PF、RP、BP、RE五個(gè)維度的得分明顯高于治療前,并且具有統(tǒng)計(jì)學(xué)意義。而MCS、GH、SF、MH、VT的得分在治療前后沒有明顯的改變。結(jié)論1.高通量血液透析能夠改善患者體內(nèi)的營養(yǎng)不良及炎癥狀態(tài)。由于炎癥與動(dòng)脈硬化密切相關(guān),因此,高通量血液透析從一定程度上能夠改善患者的血管硬化情況。2.尿毒癥患者存在肺通氣及彌散功能的降低,伴氣道阻塞。高通量血液透析治療能顯著改善氣道阻塞,但對肺通氣及彌散功能無明顯改善。3.高通量血液透析對尿毒癥患者的生存質(zhì)量評分有一定改善。
[Abstract]:The first part of high flux hemodialysis on toxin elimination of patients with uremia, anemia, secondary hyperparathyroidism, metabolism of calcium and phosphorus, ET-1, NO, influence of mean arterial pressure. Objective: This study aimed to investigate high flux hemodialysis and conventional low flux hemodialysis on maintenance hemodialysis patients with anemia, toxin removal, secondary hyperparathyroidism beside the Kang, calcium and phosphorus metabolism, ET-1, NO, influence of mean arterial pressure. For uremic patients, has an important influence on various toxin molecules in vivo on the quality of life. From this perspective, how to effectively remove the body in patients with uremia, has important clinical significance for large molecules. At present, many clinical data show that high flux hemodialysis can better remove the body of patients with uremia in large molecules. However, there is not enough data to show that the large clearance of molecules can effectively improve the urine Some complications in patients with sepsis. Therefore, to solve this problem, this part mainly discusses from the following aspects, namely high flux hemodialysis for toxin removal, anemia, secondary hyperparathyroidism, metabolism of calcium and phosphorus, ET-1, NO, mean arterial pressure. Methods: This paper selected Affiliated Hospital Medical University Of Anhui in October 2011 third to June 2012 42 cases of uremic dialysis patients, and 21 patients were randomly assigned to low flux hemodialysis group, another 21 cases assigned to high flux hemodialysis group. In addition, we also selected 24 cases of healthy control group. High amount of Fx60 dialyzer in hemodialysis group patients and low flux hemodialysis group using F7. all patients every week dialysis three times, each time 4-4.5 hours, and dialysis time was longer than three months, a stable condition. And in the process of dialysis in uremic patients. Have not received blood transfusion or immunosuppressive therapy, no trauma surgery. We were collected before and after a single dialysis of high flux hemodialysis group and low flux hemodialysis patients blood samples, each sample of 5 ml. in addition, we also selected healthy fasting blood samples. Then, we will extract these blood samples for -80~-20oC the blood samples were preserved. After centrifugation, we analyzed the high flux hemodialysis group and low flux hemodialysis group patients serum urea (BUN), phosphorus (P3+), parathyroid hormone (intact parathyroid hormone, I PIH), beta 2- microglobulin (beta beta 2-microglobulin, 2-MG) level. And then discuss the influence of high flux hemodialysis on toxin removal. In addition, we also compared the HFHD patients and LFHD hemoglobin (Hb), hematocrit (Hct), serum albumin (ALB), serum creatinine (Scr) level, Then the reaction effect on improvement of anemia. According to blood parathyroid hormone, calcium and phosphorus levels, we investigate the high flux hemodialysis on secondary hyperparathyroidism, effects of calcium and phosphorus metabolism. Moreover, we also compared the ET-1 patients with high flux hemodialysis after Ang II, the changes of NO and average artery pressure. Results 1. after high flux hemodialysis patients, BUN, Scr, serum phosphorus, 2-MG decreased significantly, therefore, compared with the conventional low flux hemodialysis, high flux dialysis blood single not only showed a similar to the small molecule clearance, and can better remove P3+, I, PTH, 2-MG and other large molecules in the beta, and the difference is significant (P 0.05).2. high flux hemodialysis after 6 months, the patient's hemoglobin (Hb), hematocrit (Hct) was significantly higher than that of conventional hemodialysis group (P 0.05).3. Qualcomm The amount of blood dialysis 6 months later, the patient's serum phosphorus, parathyroid hormone decreased significantly. Compared with low flux hemodialysis, our data suggest that high flux hemodialysis can effectively remove blood parathyroid hormone. Moreover, scavenging effect with conventional low-pass hemadialysis compared with significant difference (P0.05.4.) high flux hemodialysis after 6 months, significantly decreased levels of -1 in patients with endothelial and can increase blood levels of NO (P0.05). Conclusion: 1. high flux hemodialysis can better remove P3+, I PTH, beta 2-MG.2. high flux hemodialysis can make anemia in uremic patients was significantly improved.3. high flux hemodialysis can make uremic patients with secondary hyperparathyroidism under control of.4. high flux hemodialysis can make endothelial blood in hemodialysis patients, NO Such molecules can regulate effectively, and improve the function of vascular endothelial cells to help control blood pressure. The second part of high flux hemodialysis on uremic patients with malnutrition, inflammation and lung function, affect the quality of life score Objective: the purpose of this study is the observation of high flux hemodialysis and conventional low flux hemodialysis on maintenance hemodialysis patients with malnutrition, inflammation and lung function, affecting the quality of life score. Compared with the conventional low flux hemodialysis, high flux hemodialysis by diffusion, convection and adsorption methods, effectively promote the large clearance of molecules. However, there is not enough data to show that the large, clear the molecular can effectively improve the long-term complications of uremia patients. Therefore, to solve this problem, this part mainly discusses from the following aspects, High flux hemodialysis on malnutrition, inflammation and lung function, affecting the quality of life score. Methods: This paper selected the Third Affiliated Hospital of Medical University Of Anhui from October 2011 to June 2012 were 42 cases of uremic dialysis patients, and 21 patients were randomly assigned to low flux hemodialysis group, another 21 cases assigned to high flux hemodialysis group. In addition, we also selected 24 cases of healthy control group. High amount of Fx60 dialyzer in hemodialysis patients, and low flux hemodialysis group using F7. all patients every week dialysis three times, each time 4-4.5 hours, and dialysis time was longer than three months, and in a stable condition. In the process of dialysis, uremic patients did not receive blood transfusion or immunosuppressive therapy, no trauma surgery. We selected high flux hemodialysis group and low flux hemodialysis Before and after single dialysis patients blood samples, each sample of 5 ml. in addition, we also selected healthy fasting blood samples. Then, we will extract these blood samples for -80~-20oC were preserved. The blood samples were centrifuged and the in vivo assay of serum albumin (ALB), blood lipids, C- reactive protein (CRP). Interleukin -6 (IL-6) and the concentration, at the same time, through the determination of SGA, TSF, MAC, MAMC of high flux hemodialysis to improve hemodialysis patients with malnutrition, micro inflammatory reaction. In addition, the lung is one of the most commonly involved organs of uremia and pulmonary function in patients with uremia may be affected by many factors we compared the low flux hemodialysis and high throughput pulmonary function of the patients with hemodialysis in uremic patients, so as to explore the lung function damage characteristics and effect of high flux hemodialysis on the pulmonary function in order to explore. 璁ㄩ珮閫氶噺閫忔瀽瀵瑰翱姣掔棁鎮(zhèn)ｈ，

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