高通量血液透析联合组合型人工肾治疗对成纤维细胞生长因子-23的影响

Effect of high flux hemodialysis combined with artificial kidney on fibroblast growth factor-23

目的：观察高通量血液透析（HFHD）联合不同组合型人工肾治疗方法对维持性血液透析（MHD）患者成纤维细胞生长因子-23（FGF-23）的影响。方法选择上海第八五医院肾脏科血液净化中心长期规律行HFHD的患者80例，所有患者首先接受1个月的单纯HFHD，再按随机原则接受HFHD后血液灌流（HP）治疗（HFHD＋HP方案）或HP后HFHD治疗（HP＋HFHD方案），两种方式各治疗3个月后交换进行，交换间隔为1个月（1个月内两组都进行单纯HFHD治疗），治疗两个周期共8个月。单纯HFHD时第1个月血液净化前后留取血清标本，HFHD＋HP方案和HP＋HFHD方案最后1个月血液净化前后留取血清标本，检测血肌酐（SCr）、钙、磷、甲状旁腺素（iPTH）和FGF-23水平。结果 HP＋HFHD方案治疗前SCr水平较单纯HFHD时明显降低（μmol/L：773.45±212.23比803.27±192.47，P＜0.05），HFHD＋HP方案和HP＋HFHD方案治疗前血钙、血磷比较差异均无统计学意义（均P＞0.05）。HFHD＋HP方案和HP＋HFHD方案患者治疗后血iPTH、FGF-23均较单纯HFHD时显著下降（P＜0.05或P＜0.01）；HFHD＋HP方案和HP＋HFHD方案治疗后SCr、血钙变化差异均无统计学意义（均P＞0.05）；HFHD＋HP方案患者治疗后血磷、iPTH、FGF-23均较HP＋HFHD方案明显下降〔血磷（mmol/L）：1.47±0.22比1.60±0.23，iPTH（μg/L）：490.12±145.23比516.34±165.75，FGF-23（μg/L）：802.11±92.58比822.39±107.23，P＜0.05或P＜0.01〕。结论组合型人工肾较单纯HFHD在清除中大分子物质方面有较显著的效果；不同组合型人工肾治疗方案对毒素的清除率不同，HFHD＋HP方案较HP＋HFHD方案对iPTH、FGF-23等中大分子毒素的清除效果更显著。

Objective To observe the effect of high flux hemodialysis （HFHD） combined with artificial kidney on fibroblast growth factor-23 （FGF-23） in patients with maintenance hemodialysis （MHD）. Methods Eighty cases who regularly carried out long-term HFHD in nephrology blood purification center of NO.85 Hospital of PLA were enrolled. All the patients firstly received HFHD alone for 1 month, and then according to random principle, they could receive HFHD followed by hemoperfusion （HP） for treatment （HFHD＋HP group） or HP followed by HFHD for treatment （HP＋HFHD group）. These two types of treatment were respectively carried out for 3 months, and then exchanged to proceed the procedure, the interval of exchange being 1 month （in this month, the two groups of patients all underwent simple HFHD treatment）. The therapeutic course was 8 months including 2 cycles. The serum samples were taken from patients undergoing simple HFHD before and after the first month of blood purification, and patients in HFHD＋HP group and HP＋HFHD group before and after the last month for determination of serum creatinine （SCr）, calcium, phosphorus, parathyroid hormone （iPTH）, FGF-23 levels. Results The SCr level in HFHD ＋ HP group before hemodialysis was significantly lower than that in simple HFHD group （μmol/L：773.45±212.23 vs. 803.27±192.47, P〈0.05）, there were no significant differences in blood calcium and phosphorus before hemodialysis between HFHD＋HP group and HP＋HFHD group （all P〉0.05）. After hemodialysis, the serum iPTH, FGF-23 were dropped significantly in HFHD ＋ HP and HP ＋ HFHD groups compared with those in simple HFHD group （P 〈 0.05 or P 〈 0.01）. After hemodialysis, there were no statistically significant differences in SCr and calcium levels between the above two groups （both P〉0.05）. But the levels of serum phosphorus, iPTH, and FGF-23 in HFHD＋HP group were significantly lower than those of HP＋HFHD group [serum phosphorus （mmol/L）：1.47±0.22 vs. 1.60±0.23, iPTH （μg/L）：490.12±145.23 vs. 516.34±165.75, FGF-23 （μg/L）： 802.11±92.58 vs. 822.39±107.23, P 〈 0.05 or P 〈 0.01]. Conclusions In the aspect of elimination of large and medium sized molecules, the effect of combined artificial kidney is much better than that of simple HFHD. The rates of toxin elimination in different types of combined artificial kidney treatment are different, and the HFHD＋HP type has greater effect than HP＋HFHD type on elimination of toxins with large or medium sized molecules such as iPTH, FGF-23, etc.