血液净化与肾性骨关节病98例临床分析  

Clinical Analysis of 98 Cases about Blood Purification and Renal Osteoarthrosis

作　　者：曾丽花[1] 李洪[1] 曾欣[1] 陈业珍[1] 黄烈城[1] 

机构地区：[1]海南省人民医院血液净化中心,海口570311

出　　处：《医学综述》2006年第7期447-448,F0003,共3页Medical Recapitulate

摘　　要：目的探讨血液净化与净化过程中出现的透析相关性与肾性骨关节病发生的临床表现、治疗及其发病率的关系,求索其防治措施。方法收集98例患者临床资料、实验室检查、影像学检查、治疗方式及转归情况等,结合学习文献进行分析。结果实验室发现发现98例患者表现不同程度的β2-微球蛋白(β2-MG)增高、甲状旁腺素(PTH)增高、高磷低钙、代谢性酸中毒,骨关节病变等相关辅助检查异常。常规透析(HD)治疗后β2-MG无明显减少,反而升高(P>0.05),而高通量血液净化(HFP)包括高通量血液透析(HFD)、血液滤过(HF)及血液透析滤过(HDF)治疗后β2-MG有明显下降(P<0.05);维持血液净化时间越长骨关节病和继发甲状旁腺功能亢进(SHPT)的发生率越高。结论血液透析相关性骨关节病与肾性骨关节病的防治,应有效的控制饮食、合理药物的使用、充分纠正代谢性酸中毒、钙磷代谢紊乱,阻止SHPT及多种方式的血液净化交替治疗,充分清除PTH、β2-MG等尿毒症毒物,以延缓骨病关节的发生,对提高长期血液净化患者生活质量有重要意义。Objective To study the relationship between blood purification and Renal Osteoarthrosis or hemodialysis relevant Osteoarthrosis about their clinical charactere, treatments and mobidity in order to looking for the prevention and treatment methods. Method To analysis clinical data of 98 cases including clinical manifestation, laboratory and imaging examination, treatment methods and clinic prognosis combined with learned literature. Results Laboratory dates showed that 98 cases patients all had different abnormal related auxiliary examination including the increases in serum Beta2-MG, phosphate and PTH, decrease in calcium and acidosis and osteoarthrosis. The serum Beta2-MG was not decrease, but increase after conventional hemodialysis（ P 〉 0.05） ; Otherwise, the serum Beta2-MG was decreased significantly after high flux blood purification including high flux hemodialysis, hemofiltration and hemofildiatration （ P 〈 0. 05 ） ;The longer time of the blood purification, the higher incidence of osteodystrephy and secondary hyperparathreid（SHPT）. Conclusion For prevention and treatment of hemodialysis and renal relavent ostcodystrophy, the following things should be done including to control dietary effectively, to use medication reasonably, to correct acidosis and calcium/phosphate metabolism disorder, to block SHPT, to apply multiple blood purification modalities in turn, to remove uremic toxins such as PTH and Beta2-MG, to postpone the ooeuranee of renal relavent osteodystrophy. It has great significance in improving, the living quality of patients beating long time blood purification.

关 键 词：血液净化 透析性骨关节病 肾性骨关节病 

分 类 号：R692.506[医药卫生—泌尿科学] R684[医药卫生—外科学]