帕立骨化醇冲击疗法联合不同血液净化方式对维持性血液透析患者继发甲状旁腺功能亢进的作用

Effect of Paricalcitol Pulse Therapy Combined with Different Blood Purification Methods on Secondary Hyperparathyroidism in Patients with Maintenance Hemodialysis

目的探讨帕立骨化醇冲击疗法联合不同血液净化方式对维持性血液透析患者继发甲状旁腺功能亢进的效果。方法选取2020年6月-2021年6月景德镇第二人民医院收治的120例维持性血液透析患者,按照随机数表法将其分为A、B、C三组,每组各40例。所有患者采用帕立骨化醇治疗,A组在上述基础上采用高通量透析,B组在A组基础上实施血液滤过,C组在A组基础上给予血液灌流。比较三组血清酐(Scr)、尿素氮(BUN)、血钙(Ca)、血磷(P)、全段甲状旁腺激素(i PTH)、碱性磷酸酶(AKP)水平。结果组内比较,三组干预后SCr、BUN显著高于干预前(P<0.05);组间比较,A组干预后SCr、BUN显著高于B、C组(P<0.05)。组内比较,三组干预后Ca显著高于干预前,P、i PTH、AKP显著低于干预前(P<0.05);组间比较,A组干预后Ca显著低于B、C组,P、i PTH、AKP显著高于B、C组(P<0.05)。结论在帕立骨化醇治疗高通量血液透析患者基础上联合血液滤过及血液灌流可降低继发甲状旁腺功能亢进发生风险。

Objective:To investigate the effect of paricalcitol pulse therapy combined with different blood purification methods on secondary hyperparathyroidism in patients with maintenance hemodialysis.Methods:120maintenance hemodialysis patients admitted to Second People’s Hospital of Jingdezhen from June 2020 to June 2021,and were randomly divided into three groups,A,B and C,with 40 cases in each group.All patients were treated with paricalcitol.Group A was treated with high-flux dialysis on the basis of the above,group B was treated with hemofiltration on the basis of group A,and group C was given hemoperfusion on the basis of group A.The levels of serum anhydride(Scr),urea nitrogen(BUN),blood calcium(Ca),blood phosphorus(P),whole parathyroid hormone(i PTH),alkaline phosphatase(AKP)and the incidence of complications were compared among the three groups.Results:Within group comparison,SCr and BUN of the three groups after intervention were significantly higher than those before intervention(P<0.05);Compared between groups,SCr and BUN in group A after intervention were significantly higher than those in groups B and C(P<0.05).Intra-group comparison,after the intervention,the Ca of the three groups was significantly higher than that before the intervention,and the P,i PTH and AKP were significantly lower than that before the intervention(P<0.05).Compared between groups,after intervention,Ca in group A was significantly lower than that in groups B and C,while P,i PTH and AKP were significantly higher than those in groups B and C(P<0.05).Conclusion:Combining hemofiltration and hemoperfusion with paricalcitol in the treatment of high-throughput hemodialysis patients can reduce the risk of secondary hyperparathyroidism.