本文選題：血液透析　切入點(diǎn)：血液濾過(guò)　出處：《廣西醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的觀察血液透析（HD）與血液濾過(guò)(HF)治療過(guò)程中及治療后對(duì)中性粒細(xì)胞堿性磷酸酶（NAP）活性及血肌酐（Scr）、血尿素氮（BUN）、尿酸（UA）、血磷（P3-）水平的影響，探討血液透析與血液濾過(guò)兩種治療方式對(duì)中性粒細(xì)胞堿性磷酸酶（NAP）活性影響的可能機(jī)制。 方法從2013年6月至2013年9月在廣西醫(yī)科大學(xué)第一附屬醫(yī)院血液凈化中心治療的符合條件的180名終末期腎病（ESRD）維持性透析患者中隨機(jī)選取20人納入本研究。采取前瞻性、交叉對(duì)比設(shè)計(jì)，將納入本研究的20例維持性透析（MHD）患者隨機(jī)分成兩組，每組10例，每組包括男5例，女5例。第一階段其中10例接受血液透析（HD）治療，另10例接受血液濾過(guò)（HF）治療；第二階段予間隔3天后交叉替換透析方案。觀察比較這兩種血液凈化方式治療前、剛過(guò)濾器后、治療結(jié)束后對(duì)中性粒細(xì)胞堿性磷酸酶（NAP）的活性及血肌酐（Scr）、血尿素氮（BUN）、尿酸（UA）、血磷（P3-）水平的影響。 結(jié)果兩種血液凈化方式治療前全血中性粒細(xì)胞堿性磷酸酶（NAP）積分均高于正常范圍（與健康獻(xiàn)血者比），剛過(guò)濾器后及治療結(jié)束后均較治療前NAP積分降低，，差異有統(tǒng)計(jì)學(xué)意義（P＜0.01），并可以恢復(fù)到正常水平。治療過(guò)程中以剛過(guò)濾器后積分的下降率最為明顯。血液濾過(guò)（HF）組治療過(guò)程中NAP積分下降率均高于血液透析（HD）組，差異有統(tǒng)計(jì)學(xué)意義（P＜0.01）。兩種血液凈化方式治療前血肌酐（Scr）、血尿素氮（BUN）、尿酸（UA）、血磷（P3-）水平均高于正常范圍，剛過(guò)濾器后及治療結(jié)束后均較治療前Scr、BUN、UA、P3-水平降低，差異有統(tǒng)計(jì)學(xué)意義（P＜0.01）。血Scr、BUN、UA、P3-水平在治療過(guò)程中均以剛過(guò)濾器后的下降率最為明顯。血液透析（HD）組治療過(guò)程中BUN、Scr、UA下降率均高于血液濾過(guò)（HF）組，差異有統(tǒng)計(jì)學(xué)意義（P＜0.01）。而兩種血液凈化方式治療過(guò)程中血磷下降率差異均無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。血液透析（HD）組治療時(shí)，NAP與BUN、UA的治療前后下降率的變化呈正相關(guān)關(guān)系（P＜0.05），但其剛過(guò)濾器后較治療前的下降率的變化無(wú)相關(guān)關(guān)系（P＞0.05）；NAP與Scr、P3-在整個(gè)治療過(guò)程的下降率的變化無(wú)相關(guān)關(guān)系（P＞0.05）。血液濾過(guò)（HF）組治療時(shí)，NAP與Scr、BUN、UA、P3-在整個(gè)治療過(guò)程的下降率的變化均無(wú)相關(guān)關(guān)系（P＞0.05）。 結(jié)論尿毒癥患者可通過(guò)血液透析（HD）和血液濾過(guò)（HF）治療有效的清除血肌酐（Scr）、血尿素氮（BUN）、尿酸（UA）、血磷（P3-）等毒素，而且血液透析（HD）治療對(duì)Scr、BUN小分子毒素的清除效果比血液濾過(guò)（HF）治療更佳。血液透析（HD）和血液濾過(guò)（HF）治療均能將中性粒細(xì)胞堿性磷酸酶（NAP）積分降低至正常，提示血液透析（HD）和血液濾過(guò)（HF）治療均能改善中性粒細(xì)胞堿性磷酸酶（NAP）的活性，且血液濾過(guò)（HF）比血液透析（HD）的作用更佳，血液濾過(guò)（HF）治療在影響尿毒癥患者免疫功能方面有著較明顯的優(yōu)勢(shì)。血肌酐、血尿素氮等小分子毒素對(duì)中性粒細(xì)胞堿性磷酸酶活性的影響不明顯。
[Abstract]:Objective to observe the effects of hemodialysis (HD) and hemofiltration (HFV) on the activity of neutrophil alkaline phosphatase (NAPs) and the levels of serum creatinine (SCR), bun (bun), uric acid (UAA) and phosphorus (P3) during and after treatment. To explore the possible mechanism of the effect of hemodialysis and hemofiltration on the activity of neutrophil alkaline phosphatase (NAPs). Methods from June 2013 to September 2013, 20 patients with maintenance dialysis of end-stage renal disease (ESRD) who were treated in the blood purification center of the first affiliated Hospital of Guangxi Medical University were enrolled in this study. Twenty patients with maintenance dialysis (MHD) were randomly divided into two groups: 10 patients in each group, including 5 males and 5 females. In the first stage, 10 patients were treated with hemodialysis with HDD. The other 10 patients were treated with hemofiltration (HFV), the second stage was treated with cross-replacement dialysis regimen after 3 days interval. The two blood purification methods were observed and compared before and after the treatment. The effects of treatment on the activity of neutrophil alkaline phosphatase (NAPs) and the levels of serum creatinine creatinine (SCR), blood urea nitrogen (bun), uric acid (UAA), and serum phosphorus (P 3) after treatment. Results the whole blood neutrophil alkaline phosphatase (NAP) scores were significantly higher than those of healthy blood donors before and after treatment (P < 0.01). The difference was statistically significant (P < 0.01) and could return to normal level. The decrease rate of NAP score in hemofiltration group was higher than that in hemodialysis group. The difference was statistically significant (P < 0.01). The levels of creatinine creatinine, bun (bun), uric acid (UAA) and phosphorus (P3-3) were higher than those in normal range before and after treatment, and the levels of Scr-BUNU UAP3- after treatment were lower than those before treatment. The difference was statistically significant (P < 0.01). The decrease rate of Scr-BUNUAUAP3- was the most obvious in the course of treatment. The decrease rate of BUN-Scr-UA in the HD group was higher than that in the hemofiltration group. The difference was statistically significant (P < 0.01), but there was no significant difference in the decrease rate of blood phosphorus between the two blood purification methods (P > 0.05). There was a positive correlation between the decrease rate of nap and Bun UA in the HD group before and after treatment (P < 0.05), but the difference was significant (P < 0.05). There was no correlation between NAP and ScrP3- during the whole course of treatment (P > 0.05). There was no correlation between nap and Scr-BUNUAP3- during the whole course of treatment in the hemofiltration group (P > 0.05), and there was no correlation between nap and Scr-BUNUAP3- during the whole course of treatment (P > 0.05). Conclusion the patients with uremia can be effectively treated with HD and HFV) in the treatment of serum creatinine cinnamon, blood urea nitrogen bun, uric acid UAA, blood phosphorus P3-and so on. In addition, HD) therapy was better than hemofiltration therapy in the clearance of Scr-bun small molecular toxin. Both hemodialysis and hemofiltration (HFH) treatment could reduce the score of neutrophil alkaline phosphatase (NAPs) to normal. The results suggest that both hemodialysis (HD) and hemofiltration (HFH) can improve the activity of neutrophil alkaline phosphatase (NAPs), and hemofiltration with HFD is better than hemodialysis. Hemofiltration therapy has obvious advantages in affecting immune function of uremic patients. The effects of blood creatinine, blood urea nitrogen and other small molecular toxins on the activity of neutrophil alkaline phosphatase are not obvious.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R692.5

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