不同血液透析方式对患者矿物质及骨代谢的影响

Comparison of effects of different hemodialysis modilities on bone mineral metabolism

目的探讨不同血液透析方式对患者骨代谢的影响。方法在我院透析中心行维持性血液透析的患者121例,根据所使用透析器及透析方式不同,分为低通量透析组(LF组,n=23)、高通量透析组(HF组,n=64)及高通量透析滤过组(HDF组,n=34)。检测三组患者全段甲状旁腺素(intact parathyroid hormone,iPTH)及透析前后血磷、血钙和碱性磷酸酶水平。结果与LF组相比,HF组及HDF组患者透析前iPTH水平明显降低,透析后血磷的下降率明显增加,血钙水平明显升高(P<0.05),iPTH及血清磷、钙磷乘积的达标率优于LF组,但未达到统计学意义;而HF组与HDF组上述指标之间差异无统计学意义(P>0.05)。三组患者透析前血磷、总碱性磷酸酶、钙磷乘积、25(OH)D水平差异无统计学意义(P>0.05)。相关分析提示iPTH水平与透析后血钙水平有负相关关系。结论高通量血液透析及血液透析滤过治疗较低通量透析能更好地改善患者的部分矿物质骨代谢指标,可能对改善患者矿物质骨代谢异常起到有益作用。

Objective To compare the effects of different hemodialysis modilities on bone mineral metabolism. Methods One hundred and twenty one patients receiving maintenance hemodialysis were divided into low-flux dialysis（ LF, n = 23 ）, high flux dialysis （HF ,n = 64）and high-flux hemodiafiltration groups（ HDF, n = 34 ）. Patients in each group were matched with age, gender composition, dialysis age, vitamin D use. Blood intact parathyroid hormone（ iPTH）, phosphorus, calcium, and alkaline phosphatase were measured be- fore and after dialysis. Results There was no significant difference in serum phosphorus, total alkaline phosphatase, calcium phosphor- us product, and 25 （OH） D levels in the three groups before dialysis. However, the blood iPTH levels in HF and HDF groups were signif- icantly lower than that in LF groups while the phosphorus reduce rate and post-dialysis serum calcium levels were significantly higher in HF and HDF groups than that in LF dialysis group（ all P 〈 0. 05）. There was no significant difference of these indexes between HF and HDF groups. The correlation analysis showed that iPTH levels were negatively correlated with serum calcium concentrations. Conclu- sions High-flux hemodialysis and hemodiafiltration therapy can improve bone mineral metabolism better than low-flux dialysis.