三种不同血液净化方式对维持性血液透析患者高磷血症清除的临床研究

Clinical Study of Three Different Modes of Blood Purification for Clearance of Serum Phosphate in Maintenance Hemodialysis Patients

目的观察三种不同血液净化方式[血液透析(HD)、血液透析滤过(HDF)、血液透析+血液灌流(HD+HP)]对维持性血液透析患者高磷血症清除效果。方法选择2009年2月-2011年2月行维持性血液透析的48例高磷血症患者为研究对象,所有患者在低钙透析(1.25 mmol/L)的基础,随机分为HD组、HDF组、HD+HP组,每组16例,分别在治疗时及治疗后4周、8周检查钙、磷、钙磷乘积和全段甲状旁腺激素,并观察其变化。结果在治疗4周、8周后,HDF组、HD+HP组磷较前均显著下降(P值均<0.05),两组同时点相比较差异无统计学意义(P>0.05);HD组较前血磷无明显变化(P>0.05)。结论 HDF、HP清除维持性血液透析患者高磷有显著的效果,而HD效果则不佳。

Objective To study the effect of three different modes of blood purification （HD： hemodialysis, HDF： hemodiafiltration, and HD＋HP： hemodialysis and hemoperfusion） for clearance of serum phosphate in maintenance hemodialysis patients. Methods Fourty-eight patients with hyperphosphatemia undergoing maintenance hemodialysis in our department between February 2009 and February 2011 were recruited in our study. They were divided into three groups： HD group, HDF group, and HD＋HP group with 16 patients in each. Serum levels of calcium, phosphate, intact parathyroid hormone （iPTH） and calcium-phosphate product were measured and analyzed before and four, eight weeks after the therapy. Results Four and eight weeks after the therapy, concentrations of Ca, Pi, iPTH and Ca^Pi in HI） group did not obviously change （P 〉 0.05）, but levels of Pi, iPTH and CaxPi in HDF group and HD＋HP group significantly decreased compared with those before therapy （P 〈 0.05, P 〈 0.01）, except for Ca （P 〉 0.05）. At the same time, difference was not detected between HDF and HD＋HP groups （P 〉 0.05）. Conclusion HDF and HP can effectively eliminate serum phosphate in maintenance hemodialysis patients, but HD has poor effect.