3种血液净化方法对维持性血液透析患者血磷及甲状旁腺素的清除效果比较

Comparison of Clearance Effect of Three Kinds of Blood Purification Methods on Serum Inorganic Phosphorus and Parathyroid Hormone in Patients with Maintenance Hemodialysis

目的探讨3种不同血液净化方法对维持性血液透析(maintenance hemodialysis,MHD)患者血磷及甲状旁腺素(parathyro idhor mone,PTH)的清除效果。方法选取我院39例维持性血液透析患者并随机分为3组:血液灌流联合血液透析(HD+HP)组,血液透析滤过(HDF)组和血液透析(HD)组。比较3组治疗前、后血磷及血PTH清除率。结果HD组治疗后血PTH值下降,但无统计学差异(P>0.05);血磷治疗后下降且有显著性差异(P<0.05)。HDF组治疗后血PTH值及血磷值均下降且有显著性差异(P<0.05)。HD+HP组治疗后血PTH下降有显著性差异(P<0.05),且差异显著高于HDF组(P<0.05);血磷值下降且有显著性差异(P<0.05)。结论血液灌流串联血液透析及血液透析滤过均能有效清除血磷及PTH。血液透析可以有效清除血磷但不能有效清除PTH。

Objective To compare the clearance effect of three kinds of different blood purification methods on serum inorganic phosphorus and parathyroid hormone（PTH） levels in patients with maintenance hemodialysis.Methods 39 patients with maintenance hemodialysis were randomly divided into 3 groups（n=13）：hemodialysis（HD） group,hemodiafiltration（HDF） group,and hemoperfusion＋hemodialysis（HD＋HP） group.Blood samples were taken for the detection of serum inorganic phosphorus and PTH before and after the treatment.Results In HD group,the level of PTH and serum inorganic phosphorus were（638.80±200.07） pg/mL,（2.56±0.36）mmol/L before the treatment and（610.91±210.49）pg/mL,（1.80 ± 0.27）mmol/L after the treatment;in HDF group,the level of PTH and serum phosphorus were（646.07±202.33）pg/mL,（2.32±0.38）mmol/L before the treatment and（309.48±149.92）pg/mL,（1.74 ±0.35）mmol/L after the treatment;in HD＋HP group,the level of PTH and serum phosphorus were（647.74 ±185.01）pg/mL,（2.69±0.42）mmol/L before the treatment and（292.80±99.85）pg/mL,（2.11±0.29）mmol/L after the treatment,and the clearance rate of PTH was 5.32%±6.80%,40.89%±7.47%,55.52%±5.29% respectively.It satistically showed that the level of serum phosphorus decreased significantly in each group and the level of PTH decreased significantly in HDF and HD＋HP group after the treatment（P0.05）.There were also significant diffrernce between HDF and HD＋HP group for the clearance rate of PTH（P0.05）.Conclusion HDF group and HD＋HP group can safely and effectively clear serum phosphorus and PTH.Hemodialysis can effectively clear serum phosphorus,but cannot clear PTH effectively.