本文選題：高通量血液透析 + 低通量血液透析　； 參考：《新疆醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：探討常規(guī)血液透析和高通量血液透析兩種不同治療析方式對(duì)維持性血液透析患者微炎癥狀態(tài)和營養(yǎng)狀況的影響。方法：選取2011年7月至2012年11月在自治區(qū)人民醫(yī)院血凈中心長(zhǎng)期固定的50例維持性血液透析患者,將入選患者隨機(jī)分成兩組,分別使用低通和高通兩種不同的透析器進(jìn)行透析。以3個(gè)月為觀察周期,分別測(cè)定兩組患者入組后首次透析(透析前)和治療3個(gè)月后(透析前)的血漿白蛋白(Alb)、血紅蛋白(HB)、肌酐(Cr)、尿素氮(BUN)、血清C反應(yīng)蛋白(CRP)、白細(xì)胞介素-6(IL-6)、β2微球蛋白(p2-GM)、甲狀旁腺激素(PTH)的水平進(jìn)行比較,同時(shí)進(jìn)行主觀綜合性營養(yǎng)評(píng)估(subjective global assessment SGA),記錄入組時(shí)和治療3個(gè)月后的體重、體重指數(shù)、肱三頭肌皮膚皺褶厚度(TSF)、上臂中段周徑(MAC)和上臂中段肌肉周徑(MAMC)。使用游標(biāo)卡尺測(cè)量TSF用軟尺測(cè)量MAC再計(jì)算MAMC。結(jié)果：CHD組與HFHD組首次透前各項(xiàng)指標(biāo)比較無統(tǒng)計(jì)學(xué)差異(P0.05)；CHD組治療3個(gè)月后對(duì)Cr、BUN、PTH、IL-6、CRP清除無統(tǒng)計(jì)學(xué)意義(P0.05),對(duì)Alb和Hb的影響無統(tǒng)計(jì)學(xué)意義(P0.05)；HFHD組治療3個(gè)月后對(duì)BUN、Cr青除無差異(P0.05),對(duì)PTH、IL-6、CRP、β2-GM清除有統(tǒng)計(jì)學(xué)意義(P0.05),對(duì)Alb和Hb的提升有統(tǒng)計(jì)學(xué)意義(P0.05)；HFHD組與CHD組之間治療3個(gè)月后對(duì)Cr、BUN清除無統(tǒng)計(jì)學(xué)意義(P0.05),對(duì)PTH、β2-GM、IL-6、CRP清除有統(tǒng)計(jì)學(xué)意義(P0.05),對(duì)Alb、Hb的提升有統(tǒng)計(jì)學(xué)意義(P0.05)。HFHD組治療3個(gè)月后肱三頭肌皮褶厚度、上臂中段周徑測(cè)量值升高,有統(tǒng)計(jì)學(xué)意義(P0.05),兩組治療后對(duì)體重、BMI、MAMC的測(cè)量值無統(tǒng)計(jì)學(xué)意義。結(jié)論：高通量透析與常規(guī)低通量透析相比對(duì)PTH、β2-GM等大中分子毒素和IL-6和CRP等微炎癥細(xì)胞因子的清除能力更顯著,治療效果優(yōu)于常規(guī)透析�？梢愿行Ы档烷L(zhǎng)期透析病人的微炎癥狀態(tài),并使?fàn)I養(yǎng)不良狀態(tài)得到一定改善,對(duì)MHD患者的預(yù)后有著重要意義。
[Abstract]:Objective: to investigate the effect of routine hemodialysis and high flux hemodialysis on microinflammation and nutritional status of maintenance hemodialysis patients. Methods: from July 2011 to November 2012, 50 patients with maintenance hemodialysis were selected from Xuejing Center of Autonomous region people's Hospital. The patients were randomly divided into two groups. The patients were dialyzed with two different dialyzers, low pass dialyzer and Qualcomm dialyzer. Take three months as the observation cycle, The plasma albumin Albbumin (AlbN), hemoglobin (HB), creatinine (Cr), bun (bun), serum C-reactive protein (CRP), interleukin-6 (IL-6), 尾 2 microglobulin (尾 2 microglobulin p2-GM) were measured in the two groups after first dialysis (before dialysis) and 3 months after treatment (before dialysis), respectively. The levels of parathyroid hormone (PTH) were compared. At the same time, subjective global assessment SGAA was used to record the body weight, body mass index, skin crease thickness of triceps brachii, circumference of middle arm of upper arm and peripheral diameter of muscle of middle arm of upper arm. Using Vernier caliper to measure TSF use soft ruler to measure MAC and calculate MAMCs. Results there was no significant difference in the indexes before the first dialysis between the HFHD group and the control group. There was no significant difference in the clearance of IL-6 and CRP between the two groups after 3 months of treatment. There was no significant difference in the effect on Alb and HB in the Alb and HB group after 3 months of treatment. There was no difference between the two groups after 3 months of treatment. There was significant difference in the clearance of Alb and HB. There was no significant difference in the clearance of CRP, 尾 2-GM and Cr bun after 3 months of treatment between CHD group and Alb group. There was a significant difference in the clearance of PTH, 尾 2-GMIL-6CRP and Albbumin HB. There was a statistical significance for the elevation of Albhib Hb in HFHD group and CHD group after 3 months of treatment, there was no significant difference in the clearance of CRP and 尾 -GMIL-6CRP, and there was a significant difference in the clearance of Alb and HB between HFHD group and CHD group after 3 months of treatment, there was no significant difference in the clearance of CRP and 尾 2-GMIL-6CRP. The skin fold thickness of triceps brachii muscle in HFHD group was 3 months after treatment. The measured value of circumference of midarm was higher than that of control group (P 0.05). There was no significant difference in the measurement of BMIM MAMC between the two groups after treatment. Conclusion: compared with conventional low-flux dialysis, high-throughput dialysis has better clearance ability of large and medium molecular toxins such as PTH, 尾 2-GM and microinflammatory cytokines such as IL-6 and CRP, and the therapeutic effect is better than that of routine dialysis. It is more effective to reduce microinflammation and improve malnutrition in long-term dialysis patients, which is of great significance to the prognosis of patients with MHD.
【學(xué)位授予單位】：新疆醫(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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