血液灌流串联血液透析滤过改善尿毒症并发甲状旁腺功能亢进

Clinical Observation of Improving Uremia Combined with Hyperparathyroidism by Treatment of Hemoperfusion Series Coupling Hemodiafiltration

目的探讨血液灌流(hemoperfusion,HP)串联血液透析滤过(hemodiafiltration,HDF)对改善尿毒症并发甲状旁腺功能亢进(甲旁亢)的疗效。方法将慢性肾功能衰竭尿毒症继发性甲旁亢60例随机分为A、B两组。A组行高通量透析,B组行HP串联HDF,分别于首次治疗前后及治疗12周前后测定甲状旁腺素(PTH)、血尿素(blood urea nitrogen,BUN)、血肌酐(serum creatinine,SCr)、血清钙(calcium,Ca2+)、血磷(phosphorus,P3+)、血红蛋白(Hb)、红细胞压积(HCT)、血压及促红素用量,观察两组改善继发性甲旁亢各指标的效果。结果两组患者首次治疗前PTH、Hb、HCT、BUN、SCr、Ca2+、P3+、促红素第1周用量、血压等比较差异均无统计学意义(P>0.05);首次治疗后PTH、肾功能比较差异有统计学意义(P<0.05);末次治疗前PTH、Hb、HCT、BUN、SCr、Ca2+、P3+、促红素第12周用量、血压等比较差异有统计学意义(P<0.05);末次治疗后PTH比较差异有统计学意义(P<0.05)。结论 HP串联HDF能有效改善尿毒症继发性甲旁亢各项指标。

Objective To discuss the curative effect of improvement of uremia combined with hyperparathyroidism by hemoperfusion （HP） series coupling hemodiafiltration （HDF） treatment. Methods Sixty patients with uremia combined with secondary hyperparathyroidism during August 2008 and August 2011 were randomly divided into group A and group B. Group A was treated with high-flux hemodialysis （HF- HD） ; while group B was treated with hemoperfusion （HP） series coupling hemodiafihration （HDF）. The parathyroid hormone （PTH）, blood urea nitrogen （BUN）, serum creatinine （SCr）, serum calcium （Ca^2＋）, phosphorus （P^3＋）, hemoglobin （Hb）, hematocrit （HCT）, blood pressure and erythropoietin dosage of the two groups were detected before and after the first treatment, and at thel2th week after treatment. Indexes of improving secondary hyperparathyroidism of the two groups were also observed. Results The differences of the two groups were not statistically significant in PTH, Hb, HCT, BUN, SCr, Ca^2＋ , P^3＋ , the first week dose of erythropoietin and bk,3d pressure （P 〉0.06） ; After first treatment, the differences were statistically significant in FFH and renal function （P 〈0. 06）; Before the last treatment there were statistically significant in PTH, Hb, HCT, BUN, SCr, Ca^2＋ , P^3 ＋ , the 12th week dose of erythropoietin and blood pressure （P 〈 0. 06） ; After the last treatment the difference in PTH was statistically significant （P 〈0. 06）. Conclusion The method of HP series coupling HDF e, an eftectively improve indexes of uremia combined with secondaLw hyperparathyroidism.