多种透析方法联合应用于尿毒症的治疗观察及对患者PTH、25-羟基维生素D水平的影响  

Treatment of uremia with multiple dialysis methods and effects on PTH,25-D levels of hydroxyvitamins in patients

作　　者：熊小荣 黄玉麟 李彦黎 XIONG Xiao-rong;HUANG Yu-lin;LI Yan-li(Department of Laboratory Medicine,Chongqing Fifth People's Hospital,Chongqing 400062,China;Department of Laboratory Medicine,Wuxi County Hospital of Traditional Chinese Medicine,Chongqing 405800,China)

机构地区：[1]重庆市第五人民医院检验科,重庆400062 [2]重庆市巫溪县中医院检验科,重庆405800

出　　处：《临床和实验医学杂志》2021年第14期1517-1521,共5页Journal of Clinical and Experimental Medicine

基　　金：重庆市卫生计生委医学科研项目(编号:2017MSXM152)。

摘　　要：目的观察多种透析方法联合应用于尿毒症治疗观察及对患者甲状旁腺激素(PTH)、25-羟基维生素D水平的影响。方法回顾性选取2019年1月至2020年10月重庆市第五人民医院收治的尿毒症患者415例,根据治疗方案不同分为2组。观察组215例,采用血液透析(HD)+血液透析滤过(HDF)治疗,对照组200例采用HD治疗。记录2组患者治疗前和治疗3个月后的肾功能指标、电解质指标、PTH、25-羟基维生素D、同型半胱氨酸(Hcy)及生活质量评分、改良主观整体评估(MQSGA)评分的变化。结果与治疗前比较,治疗3个月后,2组患者的血肌酐、尿素氮、血尿酸、PTH、25-羟基维生素D、Hcy水平显著下降,且观察组肾功能相关指标及PTH、25-羟基维生素D、Hcy显著低于对照组,差异均有统计学意义(P<0.05)。与治疗前比较,治疗3个月后,2组患者的钙(Ca)、磷(P)、钙磷乘积(Ca×P)、钾(K)、铁(Fe)显著下降,差异均有统计学意义(P<0.05),钠(Na)、氯(Cl)与治疗前比较,差异均无统计学意义(P>0.05);且观察组治疗3个月后Ca、P、Ca×P、K、Fe低于对照组,差异均有统计学意义(P<0.05),Na、Cl与对照组比较,差异均无统计学意义(P>0.05)。与治疗前比较,治疗3个月后,2组患者的生活质量评分上升,MQSGA评分下降,且观察组生活质量评分高于对照组,MQSGA评分低于对照组,差异均有统计学意义(P<0.05)。结论HD+HDF联合与单独HD应用于尿毒症治疗均可改善肾功能,平衡电解质,降低PTH、25-羟基维生素D、Hcy的表达,但HD+HDF联合较单独HD效果更突出。Objective To observe the effect of multiple dialysis methods combined with uremia treatment on parathyroid hormone(PTH)and 25-hydroxyvitamin D levels.Methods From January 2019 to October 2020,415 patients with uremia admitted to Chongqing Fifth People's Hospital were selected retrospectively and divided into 2 groups according to different treatment options.The observation group 215 cases were treated with hemodialysis(HD)+hemodiafiltration(HDF),and the control group 200 cases were treated with HD.The changes of quality of life score,modified subjective overall assessment(MQSGA)score and renal function index,electrolyte index,PTH,25-hydroxyvitamin D,homocysteine(Hcy)before treatment and after 3 months of treatment were recorded.Results After 3 months of treatment,the serum creatinine(Scr),urea nitrogen(BUN),serum uric acid(UA),PTH,25-hydroxyvitamins in the observation group and the control group decreased compared with those before treatment,and the renal function related indexes and PTH,25-hydroxyvitamin D,Hcy in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).After 3 months of treatment,the levels of calcium(Ca),phosphorus(P),calcium-phosphorus product(Ca×P),potassium(K),iron(Fe)decreased in the observation group and control group compared with before treatment,the differences were statistically significant(P<0.05),sodium(Na),chlorine(Cl)showed no statistical significance(P>0.05).The levels of Ca,P,Ca×P,K,Fe in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05),there was no significant difference between Na,Cl and control group(P>0.05).After 3 months of treatment,the quality of life score in the observation group and the control group increased,the MQSGA score decreased,and the quality of life score in the observation group was higher than that in the control group,and the MQSGA score was lower than that in the control group,the differences were statistically significant

关 键 词：血液透析 血液透析滤过 尿毒症 甲状旁腺激素 25羟基维生素D 同型半胱氨酸 

分 类 号：R692.5[医药卫生—泌尿科学]