血液灌流串联血液透析滤过治疗尿毒症肾性纤维性骨炎临床研究

Clinical Research of Hemoperfusion Combined with Hemodiafiltration in Treatment of Renal Osteitis Fibrosa Induced by Uremia

目的比较传统血液透析(hemodialysis,HD)和血液灌流(hemoperfusion,HP)串联血液透析滤过(hemo-diafiltration,HDF)治疗尿毒症并发肾性纤维性骨炎的疗效。方法选择我院2009年10月—2011年10月慢性肾功能衰竭尿毒症期并发肾性纤维性骨炎患者40例,随机分为A、B两组。A组予传统HD,B组予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(parathyroid hormone,PTH)、成纤维细胞生长因子23(fibroblast growthfactor 23,FGF23)、骨碱性磷酸酶(bone alkaline phosphatase,BALP)、血钙、血磷,分析各指标及相关临床症状改善情况。结果两组患者首次治疗前PTH、FGF23、BALP、钙、磷及骨痛、顽固性皮肤瘙痒评分比较差异均无统计学意义(P>0.05),首次治疗后PTH、FGF23、BALP、钙、磷比较差异有统计学意义(P<0.05);末次治疗前PTH、FGF23、BALP及骨痛、顽固性皮肤瘙痒评分比较差异有统计学意义(P<0.05);末次治疗后PTH、FGF23、BALP、钙、磷比较差异有统计学意义(P<0.05)。结论 HP串联HDF能有效改善尿毒症肾性纤维性骨炎。

Objective To compare the effect of traditional hemodialysis （HD） and hemoperfusion （HP） combined with hemodiafiltration （HDF） in treatment of renal osteitis fibrosa induced by uremia. Methods A total of 40 patients with chronic renal failure combined with renal osteitis fibrosa during October 2000 and October 2011 were divided into group A trea ted with traditional HD, and group B treated with HP combined with HDF. The parathyroid hormone （PTH） , fibroblast growth factor23 （ FGF23 ） , bone alkaline phosphatase （BALP） , blood calcium and blood phosphorus were detected before and after the first treatment, and after 12 weeks of treatment. Different indexes and improvement of correlative clinical symptoms were also analyzed. Results The differences of scores in PTH, FGF23, BALP, calcium, phosphorus, bone pain and intrac table itch of skin in two groups before the first course of treatment were not statistically significant （ P 〉 0.05 ） , while the differences in PTH, FGF23, BALP, calcium and phosphorus in two groups after the first course of treatment were statistically significant （P 〈 0.05） ; the differences of scores in PTH, FGF23, BALP, bone pain and intractable itch of skin before the last course of treatment were statistically significant （ P 〈 0.05 ） ; after the last course of treatment, the differences in PTH, FGF23, BALP, calcium and phosphorus were also statistically significant （P 〈 O. 05 ）. Conclusion The method of HP com bined with HDF can effectively improve renal osteitis fibrosa induced by uremia.