血液灌流对维持性血液透析患者高磷血症的影响  

Effect of hemoperfusion on phosphorus metabolism in patients on maintenance hemodialysis

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

机构地区：[1]中国人民解放军第八五医院肾脏科,上海200052

出　　处：《诊断学理论与实践》2011年第3期221-225,共5页Journal of Diagnostics Concepts & Practice

摘　　要：目的:观察血液灌流(HP)对维持性血液透析(MHD)患者高磷血症的影响及可能的作用机制。方法:将65例MHD患者(研究组)按透析方案分为HP组(n=25)、血液透析滤过(HDF)组(n=20)及血液透析(HD)组(n=20),以24周为1个疗程。观察入选时、12周、24周各组患者的血清成纤维细胞生长因子23(FGF-23)、全段甲状旁腺激素(iPTH)、磷、钙、血清肌酐(Scr)等指标的变化,并以年龄、性别匹配的20名健康者作为对照组进行比较。结果:各研究组患者治疗前的血清FGF-23、iPTH、尿素氮(BUN)、Scr、血磷均显著高于对照组(P均<0.05),血钙则显著低于对照组(P<0.05)。HP组患者进行12周HP联合HD治疗后,其血清FGF-23较治疗前显著下降(P<0.05),进行24周的HP治疗后,其血磷、iPTH、FGF-23较治疗前显著下降(P均<0.05),血清FGF-23明显低于HDF及HD组(P均<0.01),血磷明显低于HD组(P<0.01),其他血清指标的差异均无统计学意义(P均>0.05)。结论:MHD患者普遍存在血清FGF-23、iPTH水平升高,而HP治疗可降低其FGF-23及血磷,其机制可能与HP对FGF-23的吸附、降低iPTH有关。Objective To study the effect of hemoperfusion（HP） on phosphorus metabolism in patients on maintenance hemodialysis（MHD）and its possible mechanism.Methods Sixty-five MHD patients were divided into three groups.Conventional hemodialysis（HD）,hemoperfusion（HP） and hemodiafiltration（HDF） were performed in 20 patients,25 patients and 20 patients for 24 weeks as a course,respectively.Twenty healthy people were served as controls.Serum levels of fibroblast growth factor 23（FGF-23）,intact parathyroid hormone（iPTH）,blood urea nitrogen（BUN）,phosphorus,calcium and creatinine（Scr） were measured before and at 12th,24th week of treatment.Results Serum levels of FGF-23,iPTH,BUN,Scr and phosphorus were significantly higher（P0.05） and serum calcium was significantly lower（P0.05） in MHD patients than in control group.At 12th week of treatment,serum level of FGF-23 in HP group decreased markedly（P0.05）.At 24th week of treatment,serum levels of iPTH,FGF-23 and phosphorus in HP group decreased markedly（P0.05） and the serum level of FGF-23 was significantly lower than that of HDF and HD groups（P0.01） and level of phosphorus significantly lower than that of HD group（P0.01）.Differences of other parameters were not significant（P0.05）.Conclusions Higher levels of serum FGF-23 or iPTH are universally found in MHD patients.Hemoperfusion can effectively decrease FGF-23 and blood phosphorus,and this may be related to the adsorption of FGF-23 and decrease of iPTH by hemoperfusion.

关 键 词：血液灌流 血液透析滤过 血液透析 磷 成纤维细胞生长因子23 钙 

分 类 号：R589.5[医药卫生—内分泌]