血液透析联合血液灌流、骨化三醇、维C透析液治疗血透患者骨质疏松的临床观察

The research about hemodialysis unite hemoperfusion, calcitriol, dislysate of VitC upon Osteoporosis

目的 探讨血液透析联合血液灌流、骨化三醇、维生素C透析液对维持性血液透析（MHD）患者骨质疏松的疗效.方法 将60例MHD患者按有/无骨质疏松分治疗组（A,30例,血液透析联合血液灌流、骨化三醇、维C透析液）与对照组（B,30例,单纯血液透析）.比较两组治疗6个月后患者疗效、副作用及骨密度（BMD）值、胰岛素样生长因子-1（IGF-1）、肿瘤坏死因子-a（TNF-a）、甲状旁腺素（PTH）、血肌酐（Scr）、血钙、血磷等指标变化.结果 A组疗效优于B组（P＜0.05）,两组副作用差异无统计学意义（P＞0.05）;治疗后A组BMD值、IGF-1水平高于B组,而TNF-a、血磷、PTH水平低于B组（P＜0.05）;两组治疗前后Scr、Ca水平差异无统计学意义（P＞0.05）.治疗前A组IGF-1与骨密度（BMD）值呈正相关,TNF-a、PTH、P与BMD值呈负相关,B组各指标与BMD值无线性回归关系,治疗后A组各指标与BMD值无线性回归关系.结论 血液透析联合血液灌流、骨化三醇、维C透析液治疗能显著降低血PTH、血磷、TNF-a水平,对MHD患者骨质疏松的治疗安全有效.

Objectives To explore curative effect of osteoporosis of hemodialysis unite hemoperfusion,calcitriol,dislysate of VitC in patient with maintenance hemodialysis.Methods Sixty patient who had been undergoing maintenance hemodialysis were divided into treatment group （A,30,patients who took hemodialysis unite Hemoperfusion,calcitriol,dislysate of VitC） and control group （B,40,patients who took hemodialysis alone） according to whether they had/didnt have osteoporosis.Observed curative effect,side effect and vibration of BMD,IGF-1,TNF-a,PTH,SScr,blood calcium,phosphorus,etc after treatment 6 months.Results The curative effect of group A was better than that of group B （P ＜ 0.05）,there was no significant difference of side effects between two groups（P ＞0.05） ; the levels of BMD、IGF-1 of group A were higher than those of group B after treatment ;the levels of BMD、IGF-1 of group A were higher than those of group B after treatment,and the levels of TNF-a、P、PTH of group A were lower than those of group B（P ＜ 0.05 all）,there were no significant differences of Scr,Ca levels after treatments between two groups（P ＞0.05 all）.before treatment,group A had positive correlation of BMD value,and group B had no linear regression correlation of BMD value,The levels of TNF-a、PTH 、P had negative correlation of BMD value,and IGF-1 had greatest influences on BMD value.after treatment,Indices of group A had no linear regression correlation of BMD value.Conclusions Hemodialysis unite hemoperfusion,calcitriol,dislysate of VitC could reduce the levels of PTH、p、TNF-a,it had safe and valid effect on osteoporosis in patients with maintenance hem dialysis.