目的 本研究拟探索在线血液透析滤过(online hemodiafiltration,OL-HDF)稀释方式及置换液剂量对维持性血液透析(maintenance hemodialysis,MHD)患者透析质量的影响。 方法 纳入MHD患者81例，分为A组(前稀释置换液量18L)、B组(前稀释置换液量36L)、C组(后稀释置换液量18L)，各27例，对比3组治疗12月后溶质清除率、心血管获益及生活质量、不良反应发生情况。 结果 治疗后，B组患者血磷(P)、血肌酐(Scr)、胱抑素C(Cyst-C)水平大于A、C组(B组比A组：t=-2.056、-4.224、-0.349， P=0.045、＜0.001、0.029；B组比C组：t=3.070、4.633、4.110，P=0.003、＜0.001、＜0.001)，尿素清除指数(Kt/V)小于A、C组＞1.2(B组比C组:t=-4.932，P＜0.001；A组比B组：t=2.213，P=0.031)；B组β2微球蛋白(β2-MG)、全段甲状旁腺激素(iPTH)、C反应蛋白(CRP)水平小于A组(t=0.775、-2.205、3.145， P=0.042、0.032、0.003)；B组颈动脉中膜厚度、左心室质量指数水平小于A、C组(A组比B组：t=3.116、2.934，P=0.003、0.005；B组比C组：t=-2.126、-0.243，P=0.038、0.009)，左室射血分数(B组比C组： t=3.429，P=0.001；B组比A组：t=-5.107，P＜0.001)及生活质量水平评分(B组比A组：t=-3.494，P=0.001；B组比C组：t=2.988，P=0.004)大于A、C组，B组患者不良反应发生率低于A组(t=0.448，P=0.006)和C组(t=0.687，P=0.009)。 结论 2倍置换液剂量前稀释模式可保证透析充分性条件下，降低住院率及心血管死亡率，改善生活质量，安全性能高。
Objectives This study aimed to investigate the effects of online hemodiafiltration (OL-HDF) dilution methods and substitution fluid volume on dialysis quality in maintenance hemodialysis (MHD) patients. Method A total of 81 patients with MHD were divided into three groups: group A (predilution, substitution volume 18L), group B (predilution, substitution volume 36L) and group C (postdilution, substitution volume 18L). The solute clearance rates, cardiovascular benefits, quality of life, and incidence of adverse reactions were compared among the three groups after 12 months of treatment. Results After treatment, the levels of serum phosphorus (P), serum creatinine (Scr) and cystatin C(Cyst-C) in group B were higher than those in groups A and C (B vs. A：t=-2.056、-4.224、-0.349，P=0.045、＜0.001、0.029；B vs. C：t=3.070、4.633、4.110，P=0.003、＜0.001、＜0.001), while the urea clearance index (Kt/V) was lower than that of groups A and C (Kt/V >1.2; B vs. C:t=-4.932，P＜0.001; A vs. B:t=2.213，P=0.031). Group B had significantly lower levels of β2-microglobulin (β2-MG), intact parathyroid hormone (iPTH), and C-reactive protein (CRP) than Group A (t=0.775, -2.205, 3.145; P=0.042, 0.032, 0.003). Group B had significantly lower carotid intima-media thickness and left ventricular mass index levels than Groups A and C (A vs. B: t=3.116, 2.934; P=0.003, 0.005; B vs. C: t=-2.126, -0.243; P=0.038, 0.009). Its left ventricular ejection fraction (B vs. C: t=3.429, P=0.001; B vs. A: t=-5.107, P＜0.001) and quality of life scores (B vs. A: t=-3.494, P=0.001; B vs. C: t=2.988, P=0.004) were significantly higher than Groups A and C. The incidence of adverse reactions in Group B was significantly lower than in Group A (t=0.448, P=0.006) and Group C (t=0.687, P=0.009). Conclusion The predilution mode with double the substitution fluid volume (36L) can, while ensuring dialysis adequacy, reduce hospitalization and cardiovascular mortality rates, improve quality of life, and demonstrate a higher safety profile.
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