阿法骨化醇联合不同血液净化方式治疗慢性肾脏疾病矿物质和骨代谢异常临床效果观察  

Clinical Observation of Alphacalcidol Combined with Different Blood Purification Methods in the Treatment of Chronic Kidney Disease-mineral and Bone Disorder

作　　者：仇琳[1] 苏伟[1] 马世兴[1] 王勤超[1] QIU Lin;SU Wei;MA Shi-xing;WANG Qin-chao(Department of Nephrology,Baoji Central Hospital,Baoji,Shaanxi 721008,China)

机构地区：[1]宝鸡市中心医院肾内科

出　　处：《临床误诊误治》2020年第2期52-56,共5页Clinical Misdiagnosis & Mistherapy

基　　金：陕西省卫生厅科研资助项目(2012D22)

摘　　要：目的观察阿法骨化醇分别联合血液透析滤过(HDF)和血液灌流(HP)治疗慢性肾脏疾病(chronic kidney disease, CKD)矿物质和骨代谢异常的临床效果。方法选取CKD矿物质和骨代谢异常120例,根据采用血液净化方式不同将其分为观察组和对照组两组各60例。观察组采用阿法骨化醇联合HDF治疗,对照组采用阿法骨化醇联合HP治疗。观察比较两组治疗后3个月临床效果,治疗前和治疗后3个月血清钙、磷、甲状旁腺素(PTH)、骨碱性磷酸酶(BALP)、人成纤维细胞生长因子23(FGF-23)及骨保护素(OPG)水平,以及治疗过程中不良反应发生情况。结果治疗后3个月,观察组总有效率为91.67%,对照组总有效率为61.66%,观察组总有效率明显高于对照组,差异有统计学意义(P<0.01)。治疗前,两组血清钙、磷、PTH、BALP、FGF-23及OPG水平比较差异无统计学意义(P>0.05)。治疗后3个月,观察组血清钙水平较治疗前升高,血清磷、PTH、BALP、FGF-23及OPG水平较治疗前降低;对照组血清PTH、FGF-23及OPG水平较治疗前降低,差异有统计学意义(P<0.01)。治疗后3个月,观察组血清钙水平高于对照组,血清磷、PTH、BALP、FGF-23及OPG水平低于对照组,差异有统计学意义(P<0.05或P<0.01)。治疗过程中,观察组低血压、肌肉痉挛及心律失常发生率低于对照组,差异具有统计学意义(P<0.05)。结论阿法骨化醇联合HDF较联合HP治疗CKD矿物质和骨代谢异常效果好,且安全性高。Objective To observe the clinical value of alphacalcidol combined with hemodiafiltration(HDF) and hemoperfusion(HP) respectively in the treatment of patients with chronic kidney disease-mineral and bone disorder(CKD-MBD). Methods The clinical data of 120 patients with CKD-MBD treated in our hospital from August 2015 to August 2017 were selected. According to the different methods of blood purification, all patients were divided into control group(n=60) and observation group(n=60). The control group was treated with alphacalcidol combined with HP, and the observation group was treated with alphacalcidol combined with HDF. The clinical effects at three months after treatment and the changes in serum calcium, phosphorus, parathyroid hormone(PTH), bone alkaline phosphatase(BALP), human fibroblast growth factor 23(FGF-23), and osteoprotegerin(OPG) before and at three months after treatment were compared between the two groups. The adverse reactions during the treatment in the two groups were compared and analyzed. Results At 3 months after treatment, the total effective rate of the observation group was 91.67%, which was significantly higher than that(61.66%) in the control group(P<0.01). Before treatment, there was no significant difference in serum calcium, phosphorus, PTH, BALP, FGF-23 and OPG levels between the two groups(P>0.05). At 3 months after treatment, the level of serum calcium in the observation group was significantly higher, whereas the serum phosphorus, PTH, BALP, FGF-23 and OPG levels in the observation group was significantly lower, as compared with those before treatment(P<0.01). Serum PTH, FGF-23 and OPG levels in the control group were significantly lower than those before treatment(P<0.01). The serum calcium level was higher and serum phosphorus, PTH, BALP, FGF-23 and OPG levels were significantly lower in the observation group than in the control group(P<0.05 or P<0.01). The incidence of hypotension, spasticity, and arrhythmia in the observation group was significantly lower than that in the con

关 键 词：慢性肾脏疾病 矿物质和骨代谢异常 阿法骨化醇 血液透析滤过 血液灌流 

分 类 号：R692[医药卫生—泌尿科学]