不同透析方法对血液透析患者血清骨钙素、降钙素、甲状旁腺素及β_2-微球蛋白清除的影响

Effect of different hemodialysis methods on eliminating serum bone gla-protein,calcitionin,parathormone and β_2-microglobulin in patients with chronic renal disease

目的:探讨采用不同透析方法的血液透析患者血清骨钙素(bone gla-protein,BGP)、降钙素(calcitionin,CT)、甲状旁腺素(parathormone,PTH)及β2-微球蛋白(β2-microglobulin,β2-MG)等的变化规律,比较高通量血液透析(HFHD)和低通量血液透析(LFHD)的疗效。方法:选择30例维持性血液透析(maintenance hemodialysis,MHD)患者,随机分为HFHD组12例和LFHD组18例,连续观察4周。健康成人对照组20例。采用放射免疫法及化学发光法测定血透患者透析前后血清BGP、CT、PTH、β2-MG及透析4周后PTH、β2-MG等水平。结果:两组患者透析前BGP、PTH、β2-MG及P3-均较对照组升高(P<0.01),CT和Ca2+均较对照组降低(P<0.01和P<0.05);LFHD组透析后β2-MG升高(P<0.01),HFHD组降低(P<0.01);BGP、PTH在HFHD组下降更明显(P<0.01),CT在透析前后LFHD组升高,HFHD组降低(P<0.01);透析前、后和透析4周后PTH、β2-MG比较差异均有统计学意义(P<0.01)。HFHD组患者皮肤瘙痒、关节疼痛、抽搐、肌肉痉挛等症状明显缓解。结论:高通量血液透析器可用于普通透析,且透析效果更好,对清除PTH、β2-MG等大分子物质效果显著,优于LFHD。

Objective：To explore the change rule of bone gla-protein（BGP）,calcitionin（CT）,parathormone（PTH）and β2-microglobulin（β2-BG）in serum of 30 patients with chronic renal disease（CRF）by different hemodialysis methods,and compare the therapy effect between low-flux hemodialysis（LFHD）and high-flux hemodialysis（HFHD）.Methods：Thirty cases of chronic hemodialysis patients were divided into HFHD group（12 cases）and LFHD group（18 cases）,they were followed up for 4 weeks.The variation of serum levels of BGP,CT,PTH,β2-MG in CRF patients were analyzed by radioimmunoassay and chemiluminescent detection methods before and 4 week after hemodialysis.Results：The levels of BGP,PTH,β2-MG and P3-in serum of patients with CRF were higher than those of the controls（P〈0.01）,but the levels of CT and Ca2＋ were lower than that of the controls（P〈0.01 and P〈0.05）significantly;the level of β2-MG was increased in LFHD group while decrease in HFHD group,and the levels of BGP and PTH were decreased significantlyin HFHD group（P〈0.01）.CT level was increased in LFHD group while decreased in HFHD group（P〈0.01）.The levels of PTH and β2-MG were markedly reduced when post-dialysis and 4 weeks after dialysis comparing to those of pre-dialysis（P〈0.01）.The symptoms such as shin pitch,arthralgia,muscle spasm and so on in HFHD group were significantly ameliorated.Conclusions：There was a significant clinical value in testing serum BGP,CT,PTH and β2-MG concentrations for analyzing patients condition,assessing the treatment effect and estimating prognosis of patients with CRF.The efficacy of HFHD is better than that of LFHD.