高通量血液透析及高通量血液透析滤过对骨及矿物质代谢的影响  

Effects of high flux hemodialysis and high flux hemodiafiltration on mineral and bone metabolism

作　　者：郭劲[1] 马春荣[1] 余蕾[1] 陈雷[1] 王璐璐[1] 吴保春[1] 

机构地区：[1]安徽省合肥市第一人民医院蜀山分院肾内科,安徽合肥230031

出　　处：《安徽医药》2014年第2期319-321,共3页Anhui Medical and Pharmaceutical Journal

摘　　要：目的慢性肾脏病患者钙磷代谢紊乱及骨病直接影响患者最终结局,是患者高死亡率的重要原因。该文拟在探讨高通量血液透析及高通量血液透析滤过这两种不同的血液净化方式对尿毒症患者矿物质代谢和肾性骨病的影响。方法 35例接受高通量维持性血液透析1年以上患者,于高通量维持性血液透析滤过前,改用高通量血液透析滤过4、8、16、24周后,分别检测体重指数、血压,采血检测血肌酐、尿素氮、尿酸、白蛋白、血清钙、磷以及甲状旁腺激素水平变化,并计算尿素清除指数(Kt/V)。结果 35例终末期肾脏病患者高通量血液透析滤过前与高通量血液透析滤过4、8、16、24周后相比,体重指数血压、尿素氮、血肌酐、尿酸、白蛋白、Kt/V无明显的变化(P>0.05)。高通量血液透析滤过前与高通量血液透析滤过4、8、16周后比较,血清钙、血清磷、甲状旁腺激素无明显的变化(P>0.05);高通量血液透析滤过24周后,血清磷(1.91±0.49 vs 1.71±0.33)mmol·L-1及甲状旁腺激素(602.11±286.79 vs 471.81±252.69)ng·L-1明显下降(P<0.05);血清钙(2.22±0.20 vs2.19±0.23)mmol·L-1水平轻度降低,但无统计学意义(P>0.05)。结论在终末期肾脏病患者高通量透析滤过对降低血磷水平、改善继发性甲状旁腺功能亢进较单纯高通量透析明显。Objective To explore the effects of high flux hemodialysis and high flux Hemodiafiltration on mineral and bone metabolism. Methods We prospectively enrolled 35 patients who were undergoing maintenance high flux hemodialysis for at least one year,and examined body mass index（ BMI）,blood pressure（ BP）,urea nitrogen（ BUN）,creatinine（ Scr）,uric acid（ UA）,albumin（ ALB）,serum calcium,phosphorus and parathyroid hormone before high flux hemodiafiltration and after 4 weeks,8 weeks,16 weeks,24 weeks respectively and calculated Kt / V. Results By comparison of before high flux hemodiafiltration and after 4 weeks,8 weeks,16 weeks,24 weeks,there were no significant differences（ P ＆gt; 0. 05） in the levels of BMI,BP,BUN,Scr,UA,ALB,Kt / V; By contrast before high flux hemodiafiltration and after 4 weeks,8 weeks,16 weeks,there were no significant differences（ P ＆gt; 0. 05） in the levels of serum calcium, serum phosphorus and parathyroid hormone; After high flux hemodiafiltration 24 weeks,there were significant differences（ P ＆lt; 0. 05） in the levels of serum phosphorus（ 1. 91 ± 0. 49 vs 1. 71 ± 0. 33 mmol·L-1） and parathyroid hormone（ 602. 11 ± 286. 79 vs 471. 81 ± 252. 69 ng·L-1）,but no significant differences（ P ＆gt; 0. 05） in the levels of serum calcium（ 2. 22 ± 0. 20 vs 2. 19 ± 0. 23 mmol· L-1）. Conclusions High flux hemodiafiltration can obviously reduce serum phosphorus and ameliorate secondary parathyroid hormone in CKD patients.

关 键 词：高通量血液透析 高通量血液透析滤过 血清磷 血清钙 甲状旁腺激素 

分 类 号：R692.5[医药卫生—泌尿科学]