【摘要】目的探讨自动压力控制模式血液透析滤过(hemodiafiltration with automated pressure control of convection mode，ULTRAc-HDF)对尿毒症患者血β₂-微球蛋白(β₂-Microglobulin,β₂-MG)、甲状旁腺激素(parathyroid hormone，PTH)等中分子毒素的清除效果。方法选择30 例病情稳定的维持性血液透析患者，后稀释法输注置换液，分别给予自动压力控制补液模式血液透析滤过(ULTRAc-HDF)和容量控制补液模式血液透析滤过(volume-controlled mode，VOLc-HDF)治疗，自身交叉对照，观察不同模式下置换液量、跨膜压报警次数、凝血情况等，并比较2种模式HDF对β₂-MG、PTH等中分子物质的清除效果。结果ULTRAc-HDF比VOLc-HDF时置换液量显著增加[(20.78 ± 1.41)L 比(18.30 ± 0.27)L, t=9.417, P=0.000]；跨膜压高压报警次数显著降低(0比16例次)，高压报警发生人次的比较(χ²=9.231, P=0.002)，差异有统计学意义；透析器及管路凝血分级显著下降，透析器及管路发生凝血人次比较(χ²=7.680, P=0.006)，差异有统计学意义；ULTRAc-HDF组血PTH 下降率为(57.40±4.19)%，VOLc-HDF组血PTH 下降率为(51.23±6.54)%，两者对比差异有统计学意义(t=4.352，P=0.000)。ULTRAc-HDF 组血β₂-MG 下降率为(72.51±2.82)%，VOLc-HDF 组血β₂-MG 下降率为(70.81±2.93)%，两者对比差异无统计学意义(t=2.289，P=0.062)，但从趋势上来分析，ULTRAc-HDF 组血β₂-MG 下降率较高。结论自动压力控制补液模式HDF 治疗能增加置换液量，更好的清除β₂-MG、PTH 等中分子物质，且可减少跨膜压高压报警次数，降低凝血风险。

【Abstract】Objective To investigate the effect of middle molecular toxin clearance by hemodiafiltration using the automated pressure control of convection mode (ULTRAc-HDF). Method Thirty maintenance hemodialysis patients were enrolled in this self-control study. They were treated with ULTRAc-HDF followed by hemodiafiltration with volume-controlled mode (VOLc-HDF), and used post-dilution convection for all patients. We investigated the convective volumes, the times of high TMP alarm and coagulation condition in different mode, and compared the clearance for blood β₂-MG and PTH. Results The convection volume was significantly higher in ULTRAc-HDF mode than in VOLc-HDF mode (20.78 ± 1.41L vs. 18.30 ± 0.27L, t=9.417, P=0.000). The number of high TMP alarm was lower in ULTRAc-HDF mode than in VOLc-HDF mode (0 vs. 16 times, χ²=9.231, P=0.002). The prevalence of coagulation in dialyzer and dialysis tubing was significantly lower in ULTRAc-HDF mode (χ²=7.680, P=0.006). The average PTH clearance rate was higher in ULTRAc-HDF mode than in VOLc-HDF mode (57.40±4.19% vs. 51.23±6.54%; t=4.352, P=0.000). β₂-MG decreased more in ULTRAc-HDF mode (72.51±2.82%) than in VOLc-HDF mode (70.81±2.93%) but without statistical significance (t=2.289, P=0.062). Conclusions This study showed that the ULTRAc-HDF mode resulted in higher convection volumes and correspondingly higher clearance for β₂-MG and PTH, lower risk of blood clotting, and less number of high TMP alarm.