常规血液透析和血液透析滤过对骨代谢标记物的影响

Effect of different dialysis modalities on bone metabolism in hemodialysis patients

目的:分析不同透析方式[常规血液透析(HD)与血液透析滤过(HDF)]对HD患者骨代谢的影响,探讨可能的原因。方法:入选30例维持性血液透析患者,随机分为HD组(n=15)和HDF组(n=15),15例健康体检者作为正常对照组。比较入组时、透析10个月后及单次两组患者透析前后血骨钙素(BGP),β-I型胶原C-末端肽(β-CTX),I型前胶原氨基端前肽(PINP),甲状旁腺素(PTH)的变化,并比较各组间是否存在差别。结果:入组时两组BGP、β-CTX、PINP及PTH水平差异无统计学意义(P>0.05),10个月后HD组患者透析前BGP、β-CTX、PINP及PTH均高于HDF组(P<0.05),同时两组均显著高于对照组(P<0.01)。透析后HD组患者β-CTX明显下降(P<0.05),但PTH无明显变化。HDF组患者透析后BGP、β-CTX、PTH均有显著下降,其下降幅度大于HD组。两组患者透析前后PINP均无变化。结论:采用HDF可降低透析患者的骨转运指标,尤其对高PTH患者代谢指标改善效更佳。

Objective：To study the different clinical parameters of bone metabolism between hemodialysis and hemofihration patients. Methodology ：Thirty uremic patients with maintenance hemodialysis were randomly divided into hemodialysis group （HD group, n = 15 ） and hemodiafiltration group （HDF group, n = 15 ）, 15 cases of healthy persons as control group. After 10 months of dialysis, the levels of serum osteocalcin （BGP） , β-I collagen C-terminal peptide （ β- CTX）, I procollagen amino-terminal propeptide （PINP）, and parathyroid hormone （PTH） levels and changes were compared between two groups before and after dialysis. Results：All patients showed increased baseline mean values of BGP, β-CTX, PINP, and PTH （P 〈 0. 01 ）. In HD group, all these bone metabolism markers were higher than that in HDF group （ P 〈 0. 05 ）. The levels of serum BGP, β-CTX were decreased significantly after a single HD （ P 〈 0.05 ）, but serum PTH was no significant difference. In HDF Group, the levels of serum BGP, β-CTX, PTH were significantly reduced at the end of the session （P 〈 0. 01 ）, and declined more than that in HD group. However, the levels of serum PINP did not change significantly in both groups. Conclusion： Hemodiafihration might decrease bone turnover, and improve renal osteodystrophy in patients with maintenance hemodialysis, especially for high-turnover renal osteodystrophy.