不同频率血液灌流治疗对甲状旁腺激素和血清钙磷清除的研究

Clinical investigation of various hemoperfusion frequencies on cleaning parathyroid hormone, calcium and phosphorus in maintenance hemodialysis patients

目的探讨不同频率血液灌流治疗对维持性血液透析患者甲状旁腺激素和血清钙、磷清除的效果。方法选择长期维持性血液透析患者78例,随机分为4组,A组18例为对照组,常规血液透析。其余3组在常规血液透析基础上联合血液灌流,B组22例血液灌流每周1次,C组20例血液灌流每周2次,D组18例血液灌流每2周1次。4组患者均观察12周,测量治疗前及治疗后2周、4周、6周、8周、10周、12周7个时间点血清中的钙、磷和甲状旁腺激素的浓度并进行比较分析。结果①各实验组患者的血清PTH浓度随着治疗时间的延续呈下降趋势(P<0.05),常规血液透析联合血液灌流降低PTH的疗效优于常规血透(P<0.05);②每周1次、每周2次血液灌流疗效优于每2周1次(P<0.05);治疗后4周、6周时,每周2次疗效好于每周1次(P<0.05),其余时点每周1次、每周2次的疗效相当。③随着治疗时间的延续各组患者的钙磷乘积总体呈下降趋势,但各组患者的钙磷乘积下降程度无明显差异(P>0.05)。结论①采用每周1次血液灌流频率,对PTH的清除既能达到临床疗效,又能明显减少费用。②血液灌流频率越高,PTH浓度在初期下降越快。③血液灌流串联血液透析能降低钙磷乘积,但与血液灌流频率是否相关尚待证实。

Objective To investigate the best frequency of hemoperfusion （HP） on cleaning parathyroid hormone （PTH）,calcium （Ca2＋） and phosphorus （P3＋） in maintenance hemodialysis （MHD） patients.Methods A total of 78 MHD patients were recruited.They were randomly assigned into 4 groups：patients in group A were treated with hemodialysis only as the control group （n=l 8）; patients in group B,C and D were treated with the combination of hemoperfusion and hemodialysis （HP＋HD）,in which HP was performed once a week in group B （n=22）,HP twice a week in group C （n=20）,and HP once every two weeks in group D （n=18）.The treatments were lasted for 12 weeks.Serum Ca2＋,P3＋,and PTH were measured at the time points of before treatment,2nd,4th,6th,8th,10th,and 12th weeks after the treatments.Results Serum PTH decreased after the treatments in all of the 4 groups （P＜0.05）.Serum PTH decreased more in groups B,C and D （HP＋ HD groups） than in group A （P＜0.05）,and more in groups B and C than in group D （P＜0.05）.The therapeutic effect was better in group C than in group B at the 4th and 6th weeks after treatment （P＜0.05）,but was similar between groups B and C at the 2nd,8th,10th,and 12th weeks after the treatment.Calcium-phosphorus product decreased gradually in the 4 groups after the treatment,but without significant differences at different time points （P＞0.05）.Conclusion HP once a week can achieve the cleaning of PTH with relatively lower cost.The higher the HP frequency,the faster the PTH concentration falls at the early stage.The combination of HP＋HD can reduce the calcium-phosphorus product,but whether this therapeutic effect is related to HP frequency is uncertain.