血液透析联合血液滤过清除尿毒症患者血清成纤维细胞生长因子23的效果观察

Effect of hemodialysis combined hemofiltration on the level of serum fibroblast growth factor 23 in uremic patients

目的比较传统血液透析(HD)和血液透析联合血液滤过(HF)对尿毒症患者外周血成纤维细胞生长因子23(FGF23)的清除效果。方法维持性HD的慢性肾脏疾病(CKD)5期患者212例,随机分为HD组和HD联合HF组。HD组处方:3次/周,4 h/次;HD联合HF组处方:HD 2次/周,4 h/次,HF 1次/周,6 h/次。观察周期8周。两组患者在观察开始和观察结束时分别采静脉血进行以下指标检测:全自动生化仪检测血磷(P)、血钙(Ca)、尿素氮(BUN)和肌酐(Scr)水平,酶联免疫吸附测定(ELISA)法检测血清总甲状旁腺激素(iPTH)和FGF23水平,放射免疫测定法检测血浆1,25二羟基维生素D3[1,25(OH)2D3]水平。结果观察开始时两组患者血P、血Ca、BUN、Scr、iPTH、FGF23和1,25(OH)2D3均无统计学差异(P>0.05)。HD组观察结束和开始比较,血P、血Ca、iPTH、FGF23和1,25(OH)2D3均无统计学差异(P>0.05),BUN和Scr水平显著性降低(P<0.001)。HD联合HF组治疗前后比较,血Ca和1,25(OH)2D3无统计学差异(P>0.05);治疗后血P、iPTH、FGF23、BUN和Scr水平均显著性降低(P<0.001)。治疗后,HD联合HF组与单纯HD组比较,血P、iPTH和FGF23均显著降低,差异有统计学意义(P<0.001)。结论与HD比较,HD联合HF治疗模式可显著降低终末期尿毒症患者循环血中的P、iPTH和FGF23水平,表明HD联合HF治疗模式对中、大分子物质有较好的清除效果,是较理想的组合治疗模式。

Objective To compare the clear effect of serum FGF23 between traditional hemodialysis（HD）and hemodialysis combined hemofiltration（HF）in uremic patients.Methods A total of 212 patients with chronic kidney disease（CKD）at stage 5 treated with maintenance HD were enrolled in the study,and the study last for 8 weeks.Patients were divided into HD group and HD combined HF group randomly.Prescription for HD group：HD,3 times/week,4 h/time.Prescription for HD combined HF group：HF,1 time/week,6 h/time.HD,2 times/week,4 h/time.Serum phosphorus（P）,calcium（Ca）,urea nitrogen（BUN）,creatinine（Scr）,intact parathyroid hormone（iPTH）,FGF23 and 1,25（OH）2D3 levels were determined before and after the study.Results There were no significantly difference of P,Ca,BUN,Scr,iPTH,FGF23 and 1,25（OH）2D3 between HD group and HD combined HF group at the beginning of the study（P0.05）.No distinctly difference of P,Ca,iPTH,FGF23 and 1,25（OH）2D3 was found in HD group at the end of the study compared with those at the beginning of the study（P0.05）,but BUN and Scr decreased obviously（P0.001）.In HD combined HF group,no significantly difference of Ca and 1,25（OH）2D3 was found at the end of the study compared with those at the beginning of the study（P0.05）,but BUN,Scr,P,iPTH and FGF23 decreased distinctly（P0.001）.At the end of the study,P,iPTH and FGF23 decreased significantly in HD combined HF group compared with those in HD group（P0.001）.Conclusions Compared with HD,HD combined HF treatment modalities can significantly reduce the phosphorus,iPTH and FGF23 levels in circulating blood of patients with end-stage uremia,indicating that HD combined HF treatment model has a good effect to remove the macromolecule substance,HD combined HF is an ideal combination of treatment modalities.