【摘要】目的：比较三种血液净化方式对维持性血液透析患者(maintenance hemodialysis MHD)体内炎性介质和甲状旁腺激素(para-thyroid，PTH)的清除效果，并观察重组人促红细胞生成素(recombinant human erythropoietin,r-HuEPO)的疗效。方法:维持性血透患者54例，随机分为3组，即血液透析（HD）组、血液透析滤过（HDF）组、血液灌流（HD+HP）组，每组18人，每4周测一次血常规，根据贫血纠正情况调整EPO用量，随访3月，检测受试前后患者C-反应蛋白（CRP）、PTH、白细胞介素6(interleukin-6,IL-6)的水平，以r-HuEPO的用量与红细胞压积（Hct）的比值(EPO/Hct)作为r-HuEPO抵抗的指标。结果：治疗前后组内对比，HDF组和HD+HP组患者CRP、IL-6、PTH、EPO/Hct有所下降（P＜0.05），HD组各监测指标变化无统计学意义（P＞0.05）；组间对比，HDF组及HD+HP组rHuEPO用量、EPO/Hct、CRP、IL-6、PTH均低于HD组（P＜0.05），其中HD+HP组CRP、IL-6水平明显低于HDF组（P＜0.05）。单因素分析提示EPO/Hct与CRP、IL-6、PTH呈正相关。结论：HDF及HD+HP治疗能够提高尿毒症患者EPO疗效并能减少EPO用量，其机制至少部分与改善了该人群的甲状旁腺功能亢进及微炎症状态有关。

【Abstract】Objective To compare the clearance ability for middle molecular uremic toxins, like inflammatory mediators and parathyroid hormone (PTH), in maintenance hemodialysis patients (MHD) of three blood purification modalities and also evaluate the effect of recombinant human erythropoietin (r-HuEPO)in this study. Methods Fifty-four maintenance hemodialysis patients were randomly divided into three groups, namely hemodialysis (HD) group , hemodiafiltration (HDF) group , hemoperfusion (HD+HP) group，eighteen in each group. Routine blood test was checked every 4 weeks and EPO dosage according to the correction of anemia adjusted.The follow-up lasted for three months. The level of C-reactive protein (CRP), PTH, interleukin-6 (IL-6) and indicators of renal anemia were measured at the beginning and just after the trial，while r-HuEPO amount and hematocrit (Hct) ratio (EPO/Hct) was defined as r-HuEPO resistance indicators. Results Before and after the treatment, comparising in group , EPO/Hct, CRP, IL-6, PTH of patients in HDF and HD+HP group decreased obviously (P<0.05), while no significant change in each indicators was observed in HD group(P>0.05); Comparising between groups , rHuEPO dosage , EPO/Hct, CRP, IL-6 and PTH decreased obviously in HD+HP and HDF group and the CRP, IL-6 concentration was evidently lower in HD+HP group (P<0.05).correlation analysis found that CRP, IL-6 and PTH were associated with the EPO/Hct ratio. Conclusions HDF and HD+HP can improve the treatment efficacy and reduce dosage of EPO in uremic patients, while the mechanism probably has part relationship with the improvement of hyperparathyroidism and micro-inflammation status of the population.