高通量透析对维持性血液透析患者钙磷代谢的影响  

Effect of high flux hemodialysis on calcium-phosphate metabolism in patients with maintenance hemodialysis

作　　者：肖健[1] 马兵[1] 石平[1] 

机构地区：[1]四川省广元市中心医院肾内科,广元628000

出　　处：《临床肾脏病杂志》2016年第8期487-491,共5页Journal Of Clinical Nephrology

摘　　要：目的探讨高通量血液透析对维持性血液透析患者钙磷代谢的影响,为临床维持性血液透析合并有钙磷代谢紊乱的患者提供新的血液透析治疗思路。方法纳入2013年1月至2015年1月于我院门诊行维持性透析治疗且合并有高磷血症及继发性甲状旁腺功能亢进的患者80例,将其随机分为高通量血液透析组(甲组)和普通血液透析组(乙组);比较透析前及透析后3个月、6个月患者血磷、血钙、骨密度、全段甲状旁腺素(immunoreactive parathyroid hormone,iPTH)、血红蛋白(hemoglobin,Hb)、C反应蛋白(C-reactive protein,CRP)透析充分性及患者的生活质量(如皮肤瘙痒、骨痛、关节痛)的变化。采用SPSS 20.0软件进行数据分析,P<0.05表示差异有统计学意义。结果治疗3个月后甲组患者的血磷、iPTH、CRP水平较治疗前有降低,血钙及Hb较治疗前有升高,但治疗前后差异无统计学意义(P>0.05);乙组患者治疗3个月后患者的血磷、iPTH、CRP水平较治疗前升高,血钙及Hb较治疗前有降低,差异无统计学意义(P>0.05);治疗3个月后2组间比较,血磷、血钙、iPTH和CRP无差异(P>0.05)。治疗6个月后甲组患者的血磷、iPTH、CRP水平较治疗前明显降低,血钙及Hb较治疗前明显升高,治疗前后差异有统计学意义(P<0.05);乙组患者治疗6个月后患者的血磷、iPTH水平较治疗前明显升高,差异有统计学意义(P<0.05);血钙及Hb较治疗前有升高,差异无统计学意义(P>0.05);治疗6个月后2组间比较,甲组血磷、iPTH、CRP较乙组降低(P<0.05),血钙较乙组升高(P<0.05)。随着治疗时间的延长,甲组患者皮肤瘙痒、骨痛、关节痛的症状逐渐减轻,乙组患者的上述症状无明显改善;2组间比较,甲组关节痛和皮肤瘙痒较乙组明显缓解(P<0.05)。2组患者治疗前后骨密度检测、透析充分性无明显差异(P>0.05)。结论高通量血液透析对于维持性血液透析患者钙磷代谢紊乱、继发性甲状旁腺功�Objective To investigate the effect of high flux hemodialysis on calcium-phosphate metabolism in patients with maintenance hemodialysis. Methods Eighty maintenance hemodialysis patients With hyperphosphatemia and secondary hyperparathyroidism in our hospital during the period from Jan. 1, 2013 to Jan. 1, 2015 were enrolled. All of the patients were randomly divided into high flux hemodialysis group （group A）and hemodialysis group（group B）. Blood phosphate, blood calcium, bone density, PTH, Hb, CRP, and hemodialysis adequacy were compared in both groups before and at 3rd and 6th month after hemodialysis. The quality of life of patients, including itchy skin, bone pain, joint pain was observed in both two groups before and after the hemodialysis. SPSS 20. 0 software was used for data analysis, and P〈0. 05 indicated that the difference was statistically significant. Results After treatment for 3 months, blood phosphate, iPTH, and CRP in high-flux group were decreased, and blood calcium and Hb were increased as compared those before treatment, but there was no statistically significant difference （P〉0. 05）. At 6th month after hemodialysis, iPTH and CRP in high-flux group were significantly decreased, and blood calcium and Hb were obviously increased as compared with those before hemodialysis （P〈0. 05）. In regular hemodialysis group, blood phosphate, PTH and CRP were increased, and blood calcium and Hb were decreased at 3 rh month after hemodialysis, but there was no statistically significant difference （P〉0.05）. The comparison between 2 groups, no difference in serum phosphorus, calcium, iPTH and CRP（P〉0. 05）. At 6th month after hemodialysis, bood phosphate, iPTH and CRP in regular hemodialysis group were significantly increased, and blood calcium and Hb were decreased （P〈0. 05）. The comparison between 2 groups, group A, iPTH and CRP were serum phosphorus in group B decreased （P%0. 05）, calcium is B group increased （P〈0. 05） . With the prolongation of hemodialysis, it

关 键 词：高通量透析 维持性血液透析 钙磷代谢 

分 类 号：R692.5[医药卫生—泌尿科学]