常用血液净化方法对维持性血液透析患者血清甲状旁腺素的清除效果

Clearance effect of routine blood purification methods on parathyoid hormone in chronic hemodialysis patients

目的 比较 3种常用血液净化方法对维持性血液透析患者血清甲状旁腺素 (PTH)的清除效果。方法 将 90例维持性血液透析患者随机分为 3组 :血液灌流 +血液透析组 (HD +HP)、血液透析滤过组 (HDF)、血液透析组 (HD) ,HD +HP组接受树脂吸附联合血液透析治疗 ,HDF组接受血液透析滤过治疗 ,HD组接受血液透析治疗 ,放射免疫法测定血清PTH水平。结果 (1)HD +HP治疗后患者血PTH从(2 91 7± 2 37 5 )pg/ml降至 (12 2 2± 114 5 )pg/ml,平均单次清除率为 4 8 6 % ,治疗前后比较差异有显著性(P <0 0 5 ) ;(2 )HDF治疗后患者血PTH从 (32 5 9± 4 2 3 1)pg/ml降至 (90 9± 93 7)pg/ml,平均单次清除率为 5 9 5 % ,治疗前后比较差异有显著性 (P <0 0 5 ) ;(3)HD治疗后血PTH从 (2 97 7± 2 11 3)pg/ml降至(2 4 8 1± 10 5 5 )pg/ml,平均单次清除率为 13 1% ,治疗前后比较差异无显著性 (P >0 0 5 )。结论 血液灌流联合血液透析和血液透析滤过能有效地清除PTH ,两者清除率差异无显著性 ;而血液透析不能有效地清除PTH。

Objective To investigate the effect of three different blood purification methods on serum parathyroid hormone(PTH)in chronic hemodialysis patients.Methods Ninety patients were randomly devided into three groups:hemodialysis+hemoperfusion group(HD+HP),hemodiafiltration group(HDF),hemodialysis group (HD).Patients in HD+HP group were treated with resin absorptive devices combined hemodialysis,patients in HDF group treated with hemodiafiltration,and patients in HD group treated with hemodialysis.Blood iPTH was measured before and after treatments.Results (1)Serum iPTH in (HD+HP) group decreased significantly from(291.7±237.5)pg/ml to (122.2±114.5)pg/ml after treatment.Single average clearance rate was 48.6%.(2)Serum iPTH in HDF group decreased from(325.9±423.1)pg/ml to (90.9±93.7)pg/ml after treatment.Single average clearance rate was 59.5%.(3)While serum iPTH in HD group decreased significantly from(297.7±211.3)pg/ml to (248.1±105.5) pg/ml.Single average clearance rate was 13.1%.Conclusion Hemoperfusion associated with hemodialysis can safely and effectively clear PTH,while hemodialysis can not.