低分子肝素钠对血液透析患者血脂及钙磷代谢的影响

Effects of Low Molecular Weight Heparin on Hemodialysis Patients with Blood lipid and Calcium Phosphorus metabolism

目的探讨低分子肝素钠(LMWH)对于维持性血液透析(MHD)患者血脂及钙磷代谢的影响。方法选取本院2011年6—9月血液透析中心的46例MHD患者,随机分成LMWH组(24例)和普通肝素钠(UFH)组(22例),于透析前分别给予LMWH及普通肝素动脉血路端注射。在治疗前、后6个月及12个月空腹检测患者血三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、钙、磷、甲状旁腺素(PTH)、血红蛋白(Hb)。结果随访1年,46例患者均顺利完成4h/次的透析,均未出现明显的出血并发症。两组患者治疗前TG、TC、LDL-C、HDL-C、钙、磷、PTH、Hb水平比较差异无统计学意义(P>0.05);治疗后12个月,LMWH组的TC、HDL-C、PTH、磷均低于UFH组,差异有统计学意义(P<0.05);两组治疗后TG、LDL-C、钙、Hb水平比较差异无统计学意义(P>0.05)。结论长期使用LMWH抗凝剂,可使血液透析患者所存在的脂质、钙磷代谢异常得到部分缓解,提示LMWH使用安全、方便,特别适用于高脂血症、钙磷代谢紊乱患者,可代替UFH长期应用。

Objective To investigate the effect of low molecular weight heparin（LMWH） for maintenance hemodialysis（MHD） patients with lipid and calcium phosphorus metabolism.Methods Our hospital in 2011 from June to September,46 hemodialysis centers MHD patients were randomly divided into LMWH group（24 cases） and normal heparin（UFH） group（22 cases）,in pre-dialysis were given LMWH and UFH arterial road end of the injection.Before treatment,after 6 months and 12 months to detect patients with fasting serum triglyceride（TG）,total cholesterol（TC）,low-density lipoprotein-cholesterol（LDL-C）,high-density lipoprotein-cholesterol（HDL-C）,calcium,phosphorus,parathyroid hormone（PTH）,hemoglobin（Hb）.Results 1 year follow-up,46 patients were successfully completed 4h/times of dialysis,no significant bleeding complications.Two groups of patients before treatment,TG,TC,LDL-C,HDL-C,calcium,phosphorus,PTH and Hb level were no significant difference（P＞0.05）;After 6 months,12 months,TC,HDL-C,PTH and phosphorus of LMWH group were lower than the UFH group,the difference was statistically significant（P＜0.05）;After treatment,TG,LDL-C,calcium and Hb level were no significant difference between the two groups（P＞0.05）.Conclusion Long-term use of LMWH anticoagulant enable exist in hemodialysis patients lipids,calcium and phosphorus metabolism get partial remission,suggesting that LMWH use of safe,convenient,especially for hyperlipidemia,calcium phosphorus metabolism in patients,can replace UFH long-term use.