探讨心脏超声评价高通量血液透析(HFHD)改善尿毒症患者左心室功能的价值。

67例行维持性血液透析治疗的尿毒症患者，按其透析方式分为常规血液透析(HD)组(44例)和HFHD组(23例)，分别于治疗前及治疗6个月后检测两组患者血尿素氮(BUN)、血肌酐(SCr)、血钙(Ca)、血磷(P)、血尿酸(UA)、血清白蛋白(ALB)、甲状旁腺激素(PTH)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)及内皮素-1(ET-1)等生化指标，应用心脏超声测量左心室舒张末后壁厚度(LVPW)、左心室射血分数(LVEF)、二尖瓣E/A值、左心室二尖瓣环收缩期峰值位移(MAPSE)。两组患者血红蛋白(Hb)、ALB、血压、血生化指标、心功能指标均采用均数±标准差表示，显著性检验采用非配对t检验。

治疗后HD组BUN、SCr、UA、IL-6下降率[分别为(－6.50±2.51)%、(－16.94±8.13)%、(－2.50±0.98)%、(－0.31±0.12)%)]与HFHD组[分别为(－7.81±2.07)%、(－15.33±6.21)%、(－3.16±0.53)%、(－0.33±0.18)%]比较，差异无统计学意义(t＝－1.984、－0.830、1.684、0.543；P>0.05)，仅血P下降率差异有统计学意义[(－5.23±2.12)%、(－11.53±4.43)%，t＝－7.896，P<0.05]。HD组PTH、TNF-α、ET-1下降率[分别为(9.62±3.55)%、(16.31±6.83)%、(21.21±8.13)%]高于HFHD组[分别为(－22.13±7.33)%、(－19.73±7.25)%、(－31.32±12.13)%]，差异有统计学意义(t＝－23.960，－20.081，－21.110；P<0.05)。HD组LVPW的增厚率[(0.98±2.31)%]与HFHD组[(0.43±0.17)%]比较，差异无统计学意义(t＝1.136，P>0.05)。HD组E/A、LVEF、MAPSE升高率[分别为(1.42±1.16)%、(2.75±0.97)%、(2.17±0.67)%]低于HFHD组[分别为(9.02±2.74)%、(11.23±3.45)%、(17.6±4.44)%]，差异有统计学意义(t＝－15.946，－15.282，－22.716；P<0.05)。

本研究结果表明，HFHD较HD能明显改善尿毒症患者的左心室功能。

To explore the value of high-flux hemodialysis in improving left ventricular function in patients with uremia evaluated by ultrasound.

Sixty-seven patients with uremia who had been treated by maintenance hemodialysis were selected and divided into two groups according to the dialysis modality: conventional hemodialysis(HD)group(forty-four cases) and HFHD group(twenty-three cases). Urea nitrogen (BUN), creatinine(SCr), serum calcium(Ca), serum phosphorus(P), uric acid(UA), albumin(ALB), parathyroid hormone(PTH), tumor necrosis factor alpha(TNF-α), interleukin-6(IL-6), endothelin-1(ET-1) were detected in the two groups before treatment and six months after treatment, and left ventricular end-diastolic posterior wall thickness(LVPW), left ventricular ejection fraction (LVEF), mitral E/A value, left ventricular peak systolic mitral annular displacement (MAPSE) were measured by ultrasonography.The statistical method unpaired t test was used to analyse the data.

There were no significant differences in the decreasing rates of BUN, SCr, UA, IL-6 between the HD group[(6.50±2.51)%, (-16.94±8.13)%, (-2.50±0.98)%, (-0.31±0.12)%, respectively)] and the HFHD group[(-7.81±2.07)%, (-15.33±6.21)%, (-3.16±0.53)%, (-0.33±0.18)%, respectively](t=-1.984, -0.830, 1.684, 0.543; P>0.05) after treatment, there was significant difference in the decreasing rate of serum P between the two groups [(-5.23±2.12)%, (-11.53±4.43)%, t=-7.896, P<0.05]. The decline rates of PTH, TNF-α, ET-1 of the HD group[(9.62±3.55)%, (16.31±6.83)%, (21.21±8.13)%, respectively)]were lower than those of the HFHD group [(-22.13±7.33)%, (-19.73±7.25)%, (-31.32±12.13)%, respectively)](t=-23.960, -20.081, -21.110; P<0.05). The thickening rate of LVPW of the HD group[(0.98±2.31)%] had no significant difference with the HFHD group[(0.43±0.17) %] (t=1.136, P>0.05). The increasing rates of E/A, LVEF, MAPSE of the HD group[(1.42±1.16)%, (2.75±0.97)%, (2.17±0.67)%, respectively)] were lower than those of the HFHD group[(9.02±2.74)%, (11.23±3.45)%, (17.6±4.44)%, respectively) ](t=-15.946, -15.282, -22.716; P<0.05).

Compared with HD, HFHD can improve the left ventricular function of patients with uremia.