两种不同血液净化方式对血清钙磷及甲状旁腺激素清除的对比研究

Comparative study of influences of two different blood purification treatments on clearance of serum calcium,phosphorus and parathyroid hormone

目的:探讨血液灌流串联血液透析(HP+HD)与血液透析滤过(HDF)对尿毒症患者血清中钙(Ca2+)、磷(P3+)、甲状旁腺激素(PTH)清除的效果。方法:选择长期维持并规律性进行血液透析的尿毒症患者40例,随机分为HP+HD组20例,每2 w常规血液透析(HD)治疗5次,HP+HD治疗1次;HDF组20例,每2 w常规血液透析(HD)治疗5次,HDF治疗1次。两组疗程均为12 w。分别记录首次透析前后及治疗4、12 w时血清Ca2+、P3+、PTH值,并对两组进行比较。结果:两组均可使血清Ca2+、P3+、PTH值下降。首次治疗清除效果均显著(P<0.01);治疗4、12 w时,血清Ca2+、P3+的下降不及PTH下降明显,但HP+HD组较HDF组清除血清Ca2+、P3+明显(P<0.05),清除PTH更明显(P<0.01)。结论:HP+HD能有效地清除尿毒症患者血清中的Ca2+、P3+和PTH,且优于HDF,有临床推广价值。

Objective：To investigate the clearance effects of hemodiafiltration （HDF） and hemoperfusion combined with hemodialysis （ HP ＋ HD） on serum calcium （ Ca^2＋ ） , phosphorus （ p3 ＋ ） , parathyroid hormone （ PTH ） in uremic patients. Methods： 40 cases of uremia receiving regularly tong - term maintenance hemedialysis were randomly divided into two groups （ n = 20）. Every two weeks, patients in HP ＋ HD group underwent HD conventional treatment 5 times and HP ＋ HD treatment once every, two weeks, while those in HDF group underwent HD treatment 5 times and HDF treatment also once every two weeks. All of them were treated for 12 weeks. The levels of serum Ca^2＋、P^3＋ , PTH （ by chemiluminescence determination） were recorded and compared between the two groups. Results： The levels of serum Ca^2＋、P^3＋ , PTH decreased and the clearance effects of the first time were significant in both groups compared with those before treatment（ P 〈0. 01 ）. But the decline amplitude of serum Ca^2＋、P^3＋ at the 4th and 12th week was less than that of PTH. Moreover, serum Ca^2＋、P^3＋ in HP ＋ HD group were removed more markedly and PTH clearance in HP ＋ HD group was more evident than those in HDF group（ P 〈 0. 01 - 0.05 ）. Conclusion： HP combined with HD can efficiently remove the serumCa^2＋、P^3＋ and PTH in uremic patients and its clearance effect is better than HDF. This method is worthy to be promoted in clinical practice.