比较高、低通量透析对维持性血液透析患者甲状旁腺激素及钙磷代谢的影响

Comparative analysis of high and low flux dialysis on parathyroid hormone,calcium and phosphate metabolism in patients undergoing maintenance hemodialysis

目的比较高、低通量透析对维持性血液透析患者甲状旁腺激素及钙、磷代谢紊乱的影响。方法选择2010年1月至2011年6月48例维持性血液透析患者按随机数字表法分为高通量透析组及普通低通量透析组各24例,并治疗3个月。所有患者采集分组后第1天透析前及治疗3个月后透析前血标本,检测血钙、磷及甲状旁腺激素水平,同时检测患者血清尿素氮、肌酐、白蛋白、血红蛋白、β2-微球蛋白水平并比较两组透析3个月后的治疗效果。结果治疗前两组患者钙、磷及甲状旁腺激素水平比较差异无统计学意义(P均>0.05)。治疗3个月后普通低通量透析组血清钙、磷及血清全段甲状旁腺激素水平与治疗前比较差异均无统计学意义(P均>0.05);高通量透析组血清钙水平与治疗前比较差异无统计学意义(P>0.05),而磷及甲状旁腺激素水平与治疗前比较差异有统计学意义,且明显低于低通量透析组(P均<0.05);高通量透析组白蛋白、血红蛋白、β2-微球蛋白水平与普通低通量透析组比较差异有统计学意义(P均<0.05)。结论与普通低通量透析比较,高通量透析能有效地清除血磷,降低甲状旁腺激素水平,从而改善维持性血液透析患者的钙、磷代谢异常,对防治肾性骨病的发生有积极作用。

] Objective Compare the effect of high and low flux dialysis on parathyroid hormone and calcium ,phosphorus metabolism disorders in patients undergoing maintenance hemodialysis. Methods Forty-eight cases of maintenance hemodialysis patients from January 2010 to June 2011 were randomly divided into high-flux dialysis group and the ordinary low-flux dialysis group（ n = 24 each）, and underwent 3 months of treatment. Blood samples of all patients were collected before dialysis on day 1 and after 3 months of treatment. Serum calcium, phosphorus,parathyroid hormone levels were detected, and serum urea nitrogen, ereatinine, albumin, hemoglobin, 132-microglobulin levels were also detected. Efficacy was compared after 3 months treatment. Results There was no statistically differ- ence of serum calcium, phosphorus, and parathyroid hormone levels in two groups of patients before treatment （ all P 〉 0. 05 ）. After 3 months of treatment, serum calcium, phosphorus, serum intact parathyroid hormone levels of ordinary low-flux dialysis group showed no significant change （ all P 〉 O. 05 ） ; In high-flux dialysis group, serum calcium levels showed no significant change （P 〉 O. 05 ）, but phosphorus and parathyroid hormone levels showed statistically difference compared with before treatment and lower than low flux dialysis group（ all P 〈0.05 ）. Compare with ordinary low flux dialysis group, the albumin,hemoglobin, β2--microglobulin levels of high-flux dialysis group were significantly difference after treatment （ all P 〈 0. 05 ）. Conclusions Compared with the ordinary low-flux dialysis, high throughput dialysis can effectively remove phosphorus, and decrease the parathyroid hormone levels, thereby impro- ving calcium, phosphorus metabolism of patients with maintenance hemodialysis, and have a positive effect on preven- ting of renal osteodystrophy.