组合型人工肾对血液透析患者肾性骨病血清抗酒石酸性磷酸酶5b的影响

Effects of hemoperfusion combined with hemodialysis on serumal trate-resistant acid phosphatase 5b in maintenance hemodialysis patients with renal osteodystrophy

目的观察常规血液透析和组合型人工肾治疗模式对肾性骨病临床表现及钙磷代谢、钙调节激素、血清抗酒石酸性磷酸酶5b的影响,探讨组合型人工肾对肾性骨病防治作用的机制。方法确诊尿毒症行维持性血液透析患者随机分为两组:常规血液透析组(HD组)和组合型人工肾组(HD+HP组),每例患者观察期6个月,其中61例患者(HD组31例和HD+HP组30例)完成观察。对两组患者治疗前后观察:按照疼痛程度VAS评分进行评估和记录骨痛程度;检测Hb、PLT、Ca、P、CaΧP、ALB、BUN、Scr,以及全段甲状旁腺激素(iPTH)和血清抗酒石酸性磷酸酶5b(sTRACP5b)。结果①HD组和HD+HP组患者治疗前后以及组间比较,血中PLT、Ca、P、CaΧP、ALB、BUN、Scr值均未见明显差异(P>0.05)。②与HD组比较:HD+HP组患者治疗后骨痛程度明显减轻(P<0.01);HD+HP组患者治疗后Hb升高(P<0.05);HD+HP组患者治疗后血清iPTH水平及sTRACP5b水平下降均更加显著(P<0.05)。结论与常规血液透析比较,组合型人工肾治疗可以有助于改善肾性贫血,缓解骨痛,并通过影响钙调激素iPTH及骨吸收生化标志物sTRACP5b延缓维持性血液透析患者的肾性骨病的发展。

【Objective】To observe the influence of the conventional hemodialysis and the hemoperfusion combined with hemodialysis（HD＋HP） treatment modalities on the clinical manifestations of renal osteodystrophy, calcium and phosphate metabolism, calcium regulating hormones, and serum trate-resistant acid phosphatase 5b, and to discuss the action mechanism of the HD＋HP prophylaxis and treatment of renal osteodystrophy. 【Methods】Patients diagnosed with uremia receiving maintaining hemodialysis were randomly divided into two groups： conventional hemodialysis group（HD group） and the hemoperfusion combined with hemodialysis group（HD＋HP group）. Observation period of each patient is 6 months. The observation was completed with 61 cases of patients, 30 of the HD group and 31 of the HD＋HP group. The two groups of patients were observed before and after the treatment： assessing and recording pain degree in accordance with the Visual Analogue Scale（VAS）; measuring Hb, PLT, Ca, P, CaΧP, Scr, BUN, ALB, intact parathyroid hormone（iPTH） and serum tartrate-resistant acid phosphatase 5b（sTRACP5b）. 【Results】Before and after the treatment as well as during the treatment, the two groups＇ blood PLT, ALB, Ca, P, CaΧP, BUN, and Scr values showed no significant difference（P〉0.05）. Compared with the results measured HD patients after the treatment,there was significant reduced of the ostalgia in the HD＋HP group（P 0.01）; The HD＋HP group of patients＇ Hb increased more significantly（P〈0.05）; The HD＋HP group of patients＇ serum iPTH level and sTRACP5b level decreased more significantly（P〈0.05）. 【Conclusions】 Compared with conventional hemodialysis, the HD＋HP treatment can help to improve renal anemia and alleviate ostalgia. And by influencing the calcium adjustable hormone and bone resorption biochemical markers sTRACP5b, it can delay maintaining hemodialysis patients with renal osteodystrophy developments.