不同血液净化组合方式对尿毒症患者钙磷代谢及生活质量的影响  

Effects of Different Blood Purification Combinations on Calcium and Phosphorus Metabolism and Quality of Life in Patients with Uremia

作　　者：周婉奕[1] 罗璨璟[2] ZHOU Wanyi;LUO Canjing(Zigong Fourth People’s Hospital,Zigong City,Sichuan Province 643000)

机构地区：[1]四川省自贡市第四人民医院肾内科,643000 [2]四川省自贡市第四人民医院体检中心,643000

出　　处：《医学理论与实践》2021年第9期1454-1456,1479,共4页The Journal of Medical Theory and Practice

基　　金：自贡市科技局立项科研项目(2016ZC23)。

摘　　要：目的:探讨血液透析(HD)联合血液滤过、血液灌流的组合方式治疗对于尿毒症患者钙磷代谢及生存质量的影响。方法:采用回顾性分析的方法收集新进入血液净化的尿毒症患者共90例,按照接受血液净化方式的不同分为三组:A组:单纯血液透析21例;B组:血液透析+血液滤过39例;C组:血液透析+血液滤过+血液灌流30例,观察治疗时间3个月。收集治疗前后的钙(Ca)、磷(P)、甲状旁腺激素(iPTH)、白介素6(IL-6)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)的指标以及生活质量评价量表(SF-36)评分、国际不宁腿综合征评分(IRLSSG),对比治疗前后及组间差异。结果:三组治疗后均较治疗前有显著改善,B组在P、iPTH、hs-CRP、TNF-α以及IRLSSG的情况均优于A组(P均<0.05);但在Ca、IL-6、SF-36评分等指标上,两组间的差异无统计学意义(P>0.05)。C组在iPTH、IL-6、hs-CRP、TNF-α以及SF-36评分、IRLSSG的改善情况优于B组(P均<0.05),但在Ca、P两个指标的改善上,B组与C组之间无显著差异(P>0.05)。结论:血液滤过及血液灌流能显著改善尿毒症患者体内Ca、P、iPTH指标,降低炎症指标,改善患者生活质量及不宁腿综合征的发生。并且在改善iPTH、炎症指标及生活质量、不宁腿综合征上,增加了血液滤过及血液灌流效果会更明显。Objective:To explore the effect of hemodialysis(HD)combined with hemofiltration and hemoperfusion on calcium and phosphorus metabolism and quality of life in uremic patients.Methods:A total of 90 uremic patients who were newly admitted to blood purification were collected by retrospective analysis,and were divided into three groups according to the different ways of receiving blood purification:Group A:21 cases of simple hemodialysis;Group B:39 cases of hemodialysis+hemofiltration;Group C:30 cases of hemodialysis+hemofiltration+hemoperfusion;the treatment time was observed for 3 months.The indexes of calcium(Ca),phosphorus(P),parathyroid hormone(iPTH),interleukin-6(IL-6),high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),quality of life assessment scale(SF-36)score and international restless legs syndrome score(IRLS)were collected before and after treatment.Results:After treatment,all the three groups had significant improvements.The P,iPTH,hs-CRP,TNF-α,and IRLSSG in group B were better than those in group A(all P<0.05).However,on such indicators as Ca,IL-6,and SF-36,there was no statistically significant difference between the two groups(P>0.05).Group C outperformed group B in the improvement of iPTH,IL-6,hs-CRP,TNF-α,SF-36 and IRLSSG(all P<0.05).However,there was no significant difference in the improvement of Ca and P between group B and group C(P>0.05).Conclusion:Hemofiltration and hemoperfusion can significantly improve the Ca,P,and iPTH indicators in patients with uremia,reduce inflammation indicators,improve the quality of life of patients and the occurrence of restless legs syndrome.Besides,the addition of hemofiltration and hemoperfusion could achieve more obvious effects in improving iPTH,inflammatory indicators and quality of life,and restless legs syndrome.

关 键 词：尿毒症 血液透析 钙磷代谢 甲状旁腺激素 炎症指标 生活质量评价量表 不宁腿综合征评分 

分 类 号：R459.5[医药卫生—治疗学]