摘要
目的探讨组合型人工肾技术对维持性血液透析(maintenance hemodialysis,MHD)患者矿物质代谢的影响。方法选择2012年1月至2013年8月在新乡市血液净化中心行MHD治疗3个月或以上的患者110例。按照随机数字表法将110例患者分为常规血液透析(hemodialysis,HD)组55例和组合型人工肾组55例。HD组患者每周行3次血液透析治疗,而组合型人工肾组患者每周行2次常规HD治疗加1次组合型人工肾治疗[将HD管路与血液灌流(hemoperfusion,HP)管路串联,选用透析模式,2 h后用盐水将灌流器及管路的血冲洗干净后迅速撤掉,再继续进行2 h的HD]。监测治疗前和治疗3个月后MHD患者外周血中血钙、血磷、血全段甲状旁腺素(intact parathyroid hormone,iPTH)及碱性磷酸酶(alkaline phosphatase,ALP)等矿物质代谢的评估指标。结果2组患者治疗前血钙、血磷、iPTH及ALP水平比较,差异无统计学意义(均P>0.05)。治疗3个月后,HD组血钙、iPTH和血ALP与治疗前比较,差异无统计学意义(均P>0.05);而血磷低于治疗前水平,差异有统计学意义(P<0.05)。组合型人工肾组治疗后血磷、iPTH和血ALP较治疗前均明显下降(P均<0.01),血钙明显上升(P<0.05)。2组治疗后比较,组合型人工肾组的血钙水平较HD组明显升高(P<0.05),ALP明显降低(P<0.05),而血磷、iPTH明显降低(P<0.01)。结论与常规血液透析比较,组合型人工肾治疗能有效清除血磷,降低血iPTH和ALP,升高血钙水平,从而改善MHD患者的矿物质代谢异常。
Objective To investigate the effects of hemoperfusion（HP）associated with hemodialysis（HD）on the mineral metabolism of maintenance hemodialysis（MHD）patients with uremia.Methods 110 MHD patients in the Hemopurification Center of Xinxiang from January2012 to August2013 were enrolled in this study.According to random number table method,110 cases of MHD were divided into two groups.Fifty-five patients with uremia in hemodialysis（HD）group received 3 times of routine HD treatments per week,and 55 patients with uremia in HP＋HD group received one time of HP plus HD（HP＋HD）and 2 times of routine HD treatment.The routine treatment time was 4h.The evaluation indexes of all patients were collected one day before HD and 3 months after treatment,including serum calcium,serum phosphorus,intact parathyroid hormone（iPTH）and alkaline phosphatase（ALP）.Results There were no statistically significant differences in the levels of serum calcium,phosphorus,iPTH and ALP between two groups before treatment（P〉0.05 for all）.After treatment for 3 months,the level of serum phosphorus was significantly lower than that before treatment in the HD group.In the HP＋HD group,the levels of serum phosphorus,iPTH and ALP were significantly decreased after treatment（P〈0.01）,and the level of serum calcium was higher than that before treatment.The level of serum calcium was higher in HD group than that in HD＋HP group（P〈0.05）,and the level of serum ALP was obviously decreased in HD＋HP group（P〈0.05）after treatment.The levels of serum phosphorus and iPTH in HP＋HD group were decreased significantly after treatment（all P〈0.01）.Conclusions As compared with ordinary HD,HP＋HD can effectively remove serum phosphorus and decrease the iPTH and ALP,thus improving the abnormal mineral metabolism of MHD patients with uremia.
作者
杨福燕
宋娟
段坤
YANG Fu-yan SONG Juan DUAN Kun(Department of Nephrology , the First People＇s Hospital of Xinxiang , Xinxiang 453000, Chin)
出处
《临床肾脏病杂志》
2017年第5期282-286,共5页
Journal Of Clinical Nephrology
基金
河南省卫生科技创新型人才工程专项经费资助课题:2013年新乡市重点科技攻关计划项目(No.ZG13032)
关键词
血液透析
血钙
血磷
全段甲状旁腺素
碱性磷酸酶
Hemodialysis
Serum calcium
Serum phosphorus
Intact parathyroid hormone
Alkaline phosphatase
