不同透析方式对尿毒症患者钙磷代谢影响的临床研究

Clinical study of the effect of different dialysis methods on calcium and phosphorus metabolism in uremic patients

目的观察不同透析方式对尿毒症患者钙磷代谢的影响。方法选择2013年4月~2016年5月我院收治的尿毒症行肾脏替代治疗患者195例,根据透析方式不同分为维持性腹膜透析组(PD组)、维持性血液透析组(HD组)及维持性血液透析滤过组(HDF组),各65例。PD组行连续性不卧床腹膜透析(CAPD),HD组采用维持性血液透析。HDF组使用高通量聚砜膜透析器,透析液流量及血流量同血液透析。三组患者均透析6个月。观察三组患者短期疗效,评价两组患者治疗前后血钙(Ca2+)、血磷(P3+)、甲状旁腺激素(i PTH)、1,25二羟基维生素D(1,25(OH)2D)各项指标水平变化。结果 PD组总有效率67.69%,HD组总有效率为73.85%,HDF组总有效率为78.46%,三组之间比较差异无统计学意义(P>0.05);治疗后,PD组与治疗前差异无统计学意义(P>0.05),HD及HDF组均显著高于治疗前,且HD组高于PD组,HDF组高于PD组及于HD组,差异均具有统计学意义(P<0.05);治疗后,三组患者的P3+较治疗前下降,三组均显著低于治疗前,HDF组低于PD组及HD组,差异均具有统计学意义(P<0.05);治疗后,三组患者的i PTH较治疗前下降,三组均显著低于治疗前,且HDF组最低,三组相比差异均具有统计学意义(P<0.05);治疗后,三组患者的1,25(OH)2D较治疗前升高,均显著高于治疗前,且HDF组最高,三组相比差异均具有统计学意义(P<0.05)。结论维持性血液透析滤过组相比较维持性血液透析及腹膜透析对尿毒症患者钙磷代谢具有更积极影响,可显著降低患者血磷水平,升高血钙水平,且临床使用较为安全,因此较适合临床推广使用。

Objective To observe the effect of different dialysis methods on calcium and phosphorus metabolism in uremic patients. Methods 195 patients with uremia who were given renal replacement therapy in our hospital from April 2013 to May 2016 were selected. According to different dialysis methods, the patients were divided into the maintenance peritoneal dialysis group （PD group）, maintenance hemodialysis group （HD group） and maintenance hemodialysis filter group （HDF group）, with 65 patients in each group. PD group was given continuous ambulatory peritoneal dialysis （CAPD）, HD group was given maintenance hemodialysis, and HDF group was given high-throughput polysulfone membrane dialyzer, dialysate flow and blood flow with hemodialysis. Three groups of patients were given dialysis for 6 months. The short-term efficacy was observed in the three groups of patients. Changes of the levels of serum calcium （Ca^2＋）, serum phosphorus （P^3＋）, parathyroid hormone （iPTH） and 1,25-dihydroxyvitamin D （1,25 （OH） 2D） were evaluated before and after treatment in both groups. Results The total effective rate was 67.69% in PD group, 73.85% in HD group, 78.46% in HDF group. There was no statistically significant difference between the three groups （P〉0.05）; after treatment, there was no statistically significant difference between PD group and before treatment（P〉0.05）. HD and HDF group were both significantly higher than those before treatment, and HD group was higher than PD group, HDF group was higher than PD group and HD group, and the difference was statistically significant （P〈0.05）; after treatment, the P^3＋ was decreased compared with that before treatment in the three groups, P^3＋ in the three groups was all significantly lower than that before the treatment,and HDF group was lower than PD group and HD group. The difference was statistically significant （P〈0.05）; after treatment,the iPTH in the three groups was decreased compared with that before treatment, and the three groups were significantly lower than that before treatment, and HDF group was the lowest. The difference between the three groups was statistically significant（P〈0.05）; after treatment,1,25（OH）2D in the three groups was significantly higher than that before treatment,all significantly higher than that before the treatment, and HDF group was the highest.The difference between the three groups was statistically significant （P〈O,05）. Conclusion Compared with the maintenance hemodialysis and peritoneal dialysis, the maintenance hemodialysis filter group has a more positive effect on the calcium and phosphorus metabolism in uremic patients, which can significantly reduce the level of serum phosphorus and increase the serum calcium level, and the clinical use is safer. Therefore, it is more suitable for clinical promotion and application.