不同血液净化方法对维持性血液透析患者钙磷代谢紊乱、iPTH及营养状态的影响  

Impacts of blood purification techniques on calcium and phosphorus metabolic disorders,intact parathyroid hormone and nutrition status in patients on maintenance hemodialysis

作　　者：许少英[1] 李绪城[1] 孔毓璇 唐小玲[1] Xu Shaoying;Li Xucheng;Kong Yuxuan;Tang Xiaoling(Blood Purification Center,Shantou Central Hospital,Shantou,Guangdong 515000,China)

机构地区：[1]汕头市中心医院血液净化中心,广东汕头515000

出　　处：《广州医科大学学报》2021年第4期103-107,共5页Academic Journal of Guangzhou Medical University

基　　金：汕头市科技计划医疗卫生类别项目(汕府科[2020]5号-20)。

摘　　要：目的:探究不同血液净化方法对维持性血液透析(MHD)患者钙磷代谢紊乱、甲状旁腺素(iPTH)及营养状态的影响。方法:随机数表法将本院2019年6月-2020年8月血液净化中心规律接受MHD治疗的尿毒症患者60例划为A组(普通血液透析组)、B组(血液透析+血液透析滤过组)、C组(血液透析+血液灌流组),每组各20例。观察3组不良反应情况,同时比较三组治疗前、后钙磷代谢情况、iPTH及营养相关指标[血清白蛋白(ALB)、前白蛋白(PA)、血红蛋白(Hb)]变化情况。结果:3组治疗前、后血钙对比差异无统计学意义;A组治疗后血磷水平比治疗前高(P<0.05),B、C组治疗后血磷比治疗前低,B组差异有统计学意义(P<0.05);A、B组治疗后血iPTH比治疗前高,C组治疗后血iPTH比治疗前低(P<0.05);B组与C组治疗后ALB、PA、Hb对比治疗前差异无统计学意义(P>0.05);A组治疗后ALB、PA、Hb比治疗前低(P<0.05);3组不良反应总发生率相比差异无统计学意义(P>0.05)。结论:对维持性血液透析患者采取普通血液透析治疗未能有效改善患者钙磷代谢紊乱、继发性甲旁亢及营养状态;血液透析+血液透析滤过治疗清除血磷效果最好;血液透析+血液灌流治疗能有效降低患者iPTH水平;血液透析+血液透析滤过及血液透析+血液灌流治疗不会影响患者营养状态。Objective:To investigate the impacts of blood purification techniques on calcium and phosphorus metabolic disorders,intact parathyroid hormone(iPTH)and nutritional status in patients on maintenance hemodialysis(MHD).Methods:A total of 60 uremic patients on MHD in our blood purification center between June 2019 and August 2020 were assigned to groups A(receiving usual hemodialysis),B(receiving hemodialysis+hemodiafiltration)and C(receiving hemodialysis+hemoperfusion),according to random number table(n=20 each).The three groups were recorded and compared for adverse events,and the changes in calcium and phosphorus metabolism,iPTH and nutrition-related indicators[serum albumin(ALB),prealbumin(PA),and hemoglobin(Hb)]before and after treatment.Results:There was no significant difference in blood calcium levels before or after treatment among the three groups.After treatment,the blood phosphorus level in group A was higher than baseline(P<0.05);those in groups B and C were lower than baseline,with a significant difference in group B(P<0.05).After treatment,the blood iPTH levels in groups A and B was higher than baseline,and that in group C,was lower than baseline treatment(all P<0.05).There were no significant differences in ALB,PA and Hb after treatment in group B or group C compared with baseline(all P>0.05).After treatment,the levels of ALB,PA and Hb in group A were lower compared with baseline(all P<0.05).The overall incidence of adverse events did not differ statistically among the three groups(P>0.05).Conclusion:For patients on MHD,usual hemodialysis is not effective in improving the disorders of calcium and phosphorus metabolism,secondary hyperparathyroidism and nutrition status.In these patients,hemodialysis plus hemodiafiltration leads to optimal clearance of blood phosphorus,while hemodialysis plus hemoperfusion may effectively reduce the iPTH level.Hemodialysis combined with either hemodiafiltration or hemoperfusion does not interfere with the nutrition status in the patients.

关 键 词：血液净化 维持性血液透析 钙磷代谢紊乱 IPTH 营养 

分 类 号：R459.5[医药卫生—治疗学]