血液灌流串联血液透析滤过改善尿毒症患者矿物质及骨代谢异常的临床研究

Clinical research about improving mineral metabolism and bone abnormalities by hemoperfusion combined with hemodiafiltration treatment

目的探讨血液灌流(HP)串联血液透析滤过(HDF)疗法对尿毒症患者合并矿物质及骨代谢异常的防治效果。方法将慢性肾脏病5期患者60例,随机分为A、B两组:A组30例为HP串联HDF组,给予每周一次HP串联HDF、每周两次常规血液透析;B组30例为HDF组,每周一次HDF、每周两次常规血液透析。分别在两组患者第1周首次治疗前后及第24周末次治疗前后测定全段甲状旁腺素(i PTH)、成纤维细胞生长因子-23(FGF-23)、骨碱性磷酸酶(BALP)、骨保护素(OPG)、Ca2+、P3+;分析每组患者首次治疗前后、末次治疗前后及两组患者首次治疗前后、末次治疗前后各指标相关性;多元Logistic回归分析矿物质及骨代谢异常的危险因素。结果 (1)两组患者实验室指标变化情况:A组与B组患者i PTH、FGF-23、BALP、OPG、Ca2+、P3+首次治疗前比较,差异均无统计学意义(P>0.05);两组中及两组之间PTH、FGF-23、BALP、OPG、P3+等首次治疗前后与首次治疗前比较、末次治疗后与末次治疗前比较,差异均有统计学意义(P<0.05)。(2)两组患者物质清除率比较:A组与B组患者i PTH、FGF-23、BALP、OPG、P3+清除率首次治疗后、末次治疗后比较差异均有统计学意义(P<0.05)。多元Logistic回归分析显示,血清中i PTH、FGF-23、P3+为矿物质及骨代谢异常的相对危险因素。结论 i PTH、FGF-23、BALP、OPG、P3+可作为尿毒症合并矿物质及骨代谢异常的标记物;HP串联HDF能有效清除i PTH、FGF-23、BALP、OPG、P3+,从而有利于改善尿毒症合并矿物质及骨代谢异常。

Objective To observe the control effect of uremia patients complicated with mineral and bone metabolic abnormal by the treatment of hemoperfusion(HP) combined with hemodiafiltration(HDF). Methods Sixty patients with chronic kidney disease stage 5 were randomly divided into group A(30 cases) and group B(30 cases): group A, patients were given HDF+HP once a week, routine hemodialysis twice per week; group B, patients were given HDF once a week, regular hemodialysis twice per week. Before and after one week of first treatment and 24 weekend treatment, intact parathyroid hormone(i PTH), fibroblast growth factor-23(FGF-23), bone alkaline phosphatase(BALP), osteoprotegerin(OPG), Ca2+, P3+ were detected. The correlation analysis among the indicators and Logistic regression analysis of mineral and bone metabolism risk factors were performed. Results(1) The changes of laboratory indicators of the two groups: there were no significant differences between the two groups in iPTH, FGF-23, BALP, OPG, Ca2+, P3+ for the first time before treatment(P>0.05). The differences of i PTH, FGF-23, BALP, OPG, P3+ for the first time after treatment compared with before treatment, for the last time after treatment compared with before treatment were statistically significant in and between the two groups(P<0.05).(2) Comparison of clearance rate of indicators in the two groups: the the differences of clearance rates of P3+, BALP, FGF-23, OPG and iP TH after the first treatment, and the end of the last treatment were statistically significant(P<0.05). Multivariate Logistic regression analysis showed that serum iP TH, P3+, FGF-23 were the relative risk factors for mineral and bone metabolism abnormality. Conclusion iP TH, FGF-23, BALP, OPG and P3+ can be used as diagnostic indexes of mineral and bone metabolic abnormality in uremia. HDF+HP can effectively improve FGF-23, BALP, iP TH, OPG, P3+, which is beneficial to improve the mineral and bone metabolism in uremia patients.