目的从心脏结构功能的变化探讨不同血液净化方式对维持性血液透析患者透析中低血压 (intradialytic-hypotension, IDH) 的影响。方法选择在佛山市禅城区中心医院血液透析中心符合纳入标准的IDH 患者30 例，随机分为血液透析(hemodialysis，HD)组，血液透析滤过联合血液透析(hemodiafiltration combined with hemodialysis，HDF + HD)组，血液灌流联合血液透析(hemoperfusion combined with hemodialysis，HP+HD)组，各组均为10 例，观察时间为24 周。①比较3 组患者透析中低血压的发生率。②分别在治疗前、治疗24 周后采用电化学发光法检测血清甲状旁腺激素(parathyroid hormone，PTH)；免疫荧光法检测N 末端B 型利钠肽原(NT-probrain natriuretic peptide，NT-proBNP)水平；散射比浊法检测超敏C 反应蛋白(high sensitivity C-reactive protein，Hs-CRP)的变化。③治疗24 周后采用彩色多普勒超声仪测量左室舒张末期内径、室间隔厚度、左心室射血分数(left ventricular ejection fraction，LVEF)的变化。结果①HDF+HD、HP+HD 组透析中低血压发生率明显降低(χ2=510.693，P=0.001)。②与治疗前相比，HP+HD 及HDF+HD 组均有效能清除PTH、NT-proBNP、Hs-CRP(HD 组：t1=0.304，P1=0.761；t2=0.401，P2=0.748；t3=0.312，P3=0.756；HDF + HD 组：t1=4.780，P1＜0.001；t2=4.813，P2＜0.001；t3=3.950，P3＜0.001；HP + HD 组：t1=4.586，P1＜0.001；t2=4.802，P2＜0.001；t3=3.961, P3＜0.001)，且与治疗后HD 组相比，上述指标的下降有统计学意义(PTH： F=3.161, P=0.017；NTproBNP：F=4.130，P=0.021；Hs-CRP：F=3.100，P=0.015)。③治疗24 周后，与HD 组比较，HDF+HD、HP+HD 组患者LVEF 值有显著性提高(F=6.926，P=0.002)。结论HDF+HD 或HP +HD 较HD 能改善IDH 患者心功能状态，有效降低IDH的发生率，值得推广。
Objective To explore the efficacy of different blood purification methods on intradialytic hypotension (IDH) and the changes of cardiac structure and function in maintenance hemodialysis (MHD) patients. Methods Thirty IDH patients were randomly divided into hemodialysis (HD) group (n=10), hemodiafiltration combined with hemodialysis (HDF+HD) group (n=10), hemoperfusion combined with hemodialysis (HP+HD) group (n=10), and they were observed for 24 weeks. ①The changes of blood pressure in hemodialysis sessions and the frequency of IDH were compared between the 3 groups. ②Serum parathyroid hormone (PTH), NT-probrain natriuretic peptide (NT-proBNP) and high sensitivity C-reactive protein (hs-CRP) were measured before and after the treatment for 24 weeks. ③Left ventricular diastolic diameter (LVDd), interventricular septal thickness (IVST) and left ventricular ejection fraction (LVEF) were examined by echocardiography after the treatment for 24 weeks. Results ①The frequency of IDH was significantly lower in HDF+HD and HP+HD groups than in HD group (χ2=510.693, P=0.001). ②Serum PTH, NT-proBNP, Hs-CRP levels decreased significantly in HP+HD and HDF+HD groups after the treatment for 24 weeks as compared with those before treatment (for HD group: t1=0.304, P1=0.761; t2=0.401, P2=0.748; t3=0.312, P3=0.756; for HDF+HD group: t1=4.780, P1＜0.001; t2=4.813, P2＜0.001; t3=3.950, P3＜0.001; for HP+HD group: t1=4.586, P1＜0.001; t2=4.802, P2＜0.001; t3=3.961, P3＜0.001), and were lower in HP+HD and HDF+HD groups than in HD group after the treatment for 24 weeks (for PTH: F=3.161, P=0.017; for NT-proBNP: F=4.130, P=0.021; for Hs-CRP: F=3.100, P= 0.015). ③LVEF increased significantly in HDF+HD and HP+HD groups after the treatment for 24 weeks as compared with that in HD group (F=6.926, P= 0.002). Conclusion HP+HD and HDF+HD were better than HD for the improvement of cardiac function and hemodynamic stability in IDH patients. HP+HD and HDF+HD may be used as a long-term therapy for IDH patients.
