高通量透析器对高磷血症的疗效观察

Curative Effect of High Flux Dialysis on Hyperphosphatemia

目的对比低通量透析与高通量透析器交替或连续使用后血清Ca、P及甲状旁腺激素(PTH)的变化。方法维持性血液透析(MHD)患者40例,使用130G低通量透析器>3个月,检测其血清尿素氮(BUN)、肌酐(Scr)、尿酸(UA)、血红蛋白(Hb)、白蛋白(Alb)、Ca、P、PTH水平以及皮肤瘙痒发生情况,并据此分为瘙痒组和无瘙痒组比较2组的上述指标。然后40例MHD患者,随机分为2组:HFHD-A组交替使用130G与150U透析器,HFHD-B组连续使用150U高通量透析器。治疗3个月后分别检测上述观察指标的变化及皮肤瘙痒的缓解程度。结果 40例低通量透析患者17例(42.5%)皮肤瘙痒(瘙痒组),瘙痒组血Ca、P水平高于无瘙痒组(P<0.05或P<0.01)。HFHD-A、HFHD-B各组治疗前后血BUN、Scr、UA、Hb、Alb、Ca水平差异无统计学意义(P>0.05)。HFHD-A组治疗后P水平较治疗前降低(P<0.01),HFHD-B组治疗后血P、PTH水平均较治疗前减低(P<0.05或P<0.01)。HFHD-A、HFHD-B2组1个月治疗后皮肤瘙痒发生率差异无统计学意义(P>0.05);3个月后皮肤瘙痒发生率差异有统计学意义(P<0.05)。结论交替或连续使用高通量透析器,能有效地降低血清P及PTH水平,并可缓解MHD患者皮肤瘙痒症。

Objective To compare the changes of serum calcium （Ca）, phosphorus （P） and parathyroid hormone （PTH） levels after application of low flux dialysis and high flux dialysis alternately or continually. Methods Forty patients on maintenance hemodialysis （MHD） in our hospital were chosen, who applied 130 G-low flux dialyzer more than three months （LFHD group）. The serum levels of urea nitrogen （BUN）, creatinine （Scr）, uric acid （UA）, hemoglobin （Hb）, albumin （Alb）, Ca, P and PTH were measured, and condition of pruritus of skin was observed. Forty LFHD patients were randomly divided into two groups, twenty cases in each group. HFHD-A group was given 130 G and 150 U dialyzer alternately. HFHD-B group used 150 U dialyzer continually. The above mentioned index and observations were measured and observed respectively after 3-month therapy. Results The incidence rate of pruritus was 42.5% in forty LFHD patients. The serum levels of Ca and P were significantly higher in these patients than those of patients without pruritus（P 〈 0.05 or P 〈 0.01）. There were no significant differences in serum levels of BUN, Scr, UA, Hb, Alb and Ca before and after treatment between HFHD-A and HFHD-B groups （P 〉 0.05）. After 3-month therapy, the serum P level significantly decreased than that of before treatment in HFHD-A group （P 〈 0.01）. The serum PTH level decreased also, but no significant difference （P 〉 0.05）. After 3-month therapy, the serum P and PTH levels reduced significantly than that of before treatment in HFHD-B （P 〈 0.05 or P 〈 0.01）. There was no significant difference in the occurrence of pruritus after 1 month treatment between HFHD-A and HFHD-B groups （P 〉 0.05）. There was a significant difference after 3-month therapy （P 〈 0.05）. Conclusion It can reduce the serum P and PTH levels effectively after using high flux dialyzer alternately or continually, and can improve the symptom of pruritus in patients on maintenance hemodialysis.