不同血液净化方法对慢性肾功能衰竭维持性血液透析患者血清甲状旁腺素的影响

Clearance effect of different blood purification techniques on parathyroid hormone in renal function failure patients on maintenance hcmodialysis

目的 比较不同血液净化技术对慢性肾功能衰竭(肾衰)维持性血液透析患者血清甲状旁腺素(PTH)的清除效果。方法 符合入选标准的90例慢性肾衰维持性血液透析患者随机分为血液吸附(AP)组、血液透析滤过(HDF)组、血液透析(HD)组3组。AP组接受血液吸附联合血液透析治疗,HDF组接受血液透析滤过1次,HD组接受血液透析治疗。用放射免疫法测定血清PTH水平;记录患者治疗前后血白蛋白、球蛋白、尿素氮、肌酐、PTH的变化,比较3组的肾小球滤过率(GFR)和透析时间。结果 ①AP组患者治疗后血PTH从(291.7±237.5)ng／L降至(122.2±114.5)ng／L,平均单次清除率为48.6％±55.2％,治疗前后比较有显著性差异(P<0.05);皮肤瘙痒缓解率为83.3％(10／12倒)。② HDF组患者治疗后血PTH从(325.9±423.1)ng／L降至(90.9±93.7)ng／L,平均单次清除率为59.5％±22.7％。治疗前后比较有显著性差异(P<0.05);皮肤瘙痒缓解率为50.0％(4／8例)。③HD组患者治疗后血PTH从(297.7±211.3)ng／L降至(248.1±105.5)ng／L,平均单次清除率为13.1％±30.2％,治疗前后比较无显著性差异(P>0.05);皮肤瘙痒缓解率为14.3％(1／7例)。结论 ①血液吸附联合血液透析治疗慢性肾衰能有效清除PTH,缓解皮肤瘙痒症状。②血液透析滤过能有效清除PTH,缓解皮肤瘙痒症状?

Objective To evaluate the effect of different blood purification techniques on serum parathyroid hormone(PTH) level in chronic hemodialysis(HD) patients with renal failure. Methods Ninety patients were randomly divided into three groups: absorption (AP) group, hemodiafiltration(HDF) group, and HD group. Patients in AP group received therapy with resin absorptive devices associated with HD, patients in HDF group received HDF, while patients in HD group received HD. Blood routine examination, serum albumin, globulin, blood urea nitrogen, creatinine and PTH were measured before and after these treatments, and vital signs and side effects were recorded during HD. Glomerular filtration rate(GFR) and the length of HD were compared among three group. Results ①Serum PTH in AP group was decrease from (291.7±237.5)ng/L to (122.2±114.5)ng/L, the difference was statistically significant. The mean single clearance rate was 48.6%±55.2%, the rate of relief from skin discomfort was 83.3% (10/12 cases). ㈡Serum PTH in HDF group was decreased from(325.9±423. 1)ng/I, to (90.9±93.7)ng/L, the difference was statistically significant. The mean single clearance rate was 59. 5%±22. 7% , and the rate of relief from skin discomfort was 50.0%(4/8 cases). ③Serum PTH in HD group was decreased from (297.7± 211.3)ng/L to (248.1±105.5)ng/L, which showed no statistically significant difference. The mean single clearance rate was 13.1%±30.2%, the rate of relief from skin discomfort was 14.3%(1/7 cases). Conclusion Resin absorptive devices and HDF can safely and effectively clear PTH, relieve skin discomfort; while hemodialysis alone can not.