血液灌流联合血液透析对维持性血液透析患者钙磷代谢的影响  

Effect of hemoperfusion combined with hemodialysis on phosphorus and calcium metabolism in patients on maintenance hemodialysis

作　　者：宦红娣[1] 张景红[1] 张军力[1] 陆蓓莉[1] 李萍[1] 杨黄[1] 杨峻[1] 

机构地区：[1]中国人民解放军第八五医院肾内科,上海200052

出　　处：《上海医学》2009年第9期796-799,共4页Shanghai Medical Journal

摘　　要：目的观察血液灌流(HP)联合血液透析(HD)对行维持性血液透析(MHD)患者钙磷代谢的影响及可能的作用机制。方法测定21例行MHD的患者(研究组)HP联合MHD治疗前、后的血清1,25-二羟维生素D3[1,25-(OH)2D3]、成纤维细胞生长因子23(FGF-23)、全段甲状旁腺激素(iPTH)、血清肌酐(SCr)、血钙、血磷及生化指标。透析治疗方案为每2周行5次HD,每2周行1次HP联合HD,24周为1个疗程。以年龄、性别匹配的20名健康者作为对照组。结果研究组治疗前的血清FGF-23、iPTH、尿素氮(BUN)、SCr、血磷均显著高于对照组(P值均<0.05),血钙和1,25-(OH)2D3均显著低于对照组(P值分别<0.05、0.01)。研究组进行1次及6次HP联合HD治疗后,血清BUN、SCr较治疗前显著下降(P值均<0.01),其他指标的差异均无统计学意义(P值均>0.05)。研究组患者进行12次HP联合HD治疗后,血清BUN、SCr、血磷、iPTH、FGF-23较治疗前显著下降(P值均<0.01),1,25-(OH)2D3较治疗前显著升高(P<0.01),其他指标的差异均无统计学意义(P值均>0.05)。经过12次联合治疗后,研究组的皮肤瘙痒和骨痛的视觉模拟评分均较治疗前显著降低(P值均<0.05)。结论HP联合HD治疗可以改善行MHD患者的钙磷代谢及维生素D代谢,可能与HP对FGF-23的吸附、改善维生素D缺乏的状态有关。Objective To explore the effect of hemoperfusion combined with hemodialysis （HD） on phosphorus and calcium metabolism in patients on maintenance hemodialysis （MHD） and the possible mechanisms. Methods Serum levels of 1,25-dihydroxy vitamin D3, fibroblast growth factor 23 （FGF-23）, intact parathyroid, creatinine, calcium, and phosphorus were examined in 21 patients receiving MHD （experimental group） before and after treatment with HP plus MHD. Conventional HD was performed 5 times every 2 weeks, and HP plus HD was performed once every 2 weeks. Twenty healthy subjects with matched age and sex were enrolled as control group. Results Serum levels of FGF-23, intact parathyroid （iPTH）, urea nitrogen, creatinie, and phosphorus were significantly higher in the experimental group than those in the control group （all P〈0.05）, and the levels of serum calcium and 1, 25-dihydroxy vitamin D3 were lower than those in the control group （P〈0.05 or 0.01, respectively）. After a single or 6 times of HP plus HD treatment, serum levels of urea nitrogen and creatinie were markedly down-regulated compared with those before treatment （both P〈0.01 ）, but no significant difference was found in other parameters （all P〈 0.05）. After 12 times of combined treatment, serum levels of blood urea nitrogen （BUN）, serum creatinine （SCr）, iPTH, FGF-23, and phosphorus were significantly down-regulated, while the level of 1,25-dihydrexy vitamin D3 was significantly up-regulated （all P〈0.01） compared with those before treatment; besides, the scores of skin itch and osteodynia by visual analog scale （VAS） also were significantly improved （all P〈 0.05）. Conclusion HP combined with HD can improve the metabolism of calcium and phophorus in patients on MHD, which might be related to the fact that FGF-23 can be absorbed by hemoperfusion, resulting in improvement of Vitamin D deficiency. （Shanghai Med J, 2009, 32： 796-799）

关 键 词：血液灌流 血液透析 钙 磷 成纤维细胞生长因子23 1  25-二羟维生素D3 全段甲状腺激素 

分 类 号：R692.5[医药卫生—泌尿科学]