不同血液净化方式对肾性骨病相关因素的影响

Impacts of different means of blood purification on elements related to rental osteopathy

目的比较不同血液净化方式对肾性骨病相关指标的影响。方法选取在我院血液净化中心行维持性血液透析(maintenance hemodialysis,MHD)6个月以上均符合肾性骨病诊断的患者64例,随机分为4组,即低通量血液透析(HD)、高通量血液透析(HFHD)、血液透析+血液透析滤过(HD+HDF)(1次/周)及血液透析+血液灌流(HD+HP)(1次/周),每组16例,比较各组治疗前及治疗24周后血钙(Ca)、血磷(P)、甲状旁腺激素(PTH)、碱性磷酸酶(ALP)及β2-微球蛋白(β2-MG),并计算钙磷乘积(Ca×P)。结果 HFHD组、HD+HDF组及HD+HP组治疗后与治疗前相比血P、PTH、ALP、β2-MG、Ca×P均显著下降,差异有统计学意义(P<0.05);HD+HDF组治疗后清除血P(1.91±0.19)mmol/L、β2-MG(11.32±2.61)mg/L及PTH(347.21±152.05)pg/ml优于HFHD组(1.98±0.14)mmol/L、β2-MG(17.09±5.60)mg/L及PTH(471.98±123.02)pg/ml,HD+HP组治疗后清除血P(1.92±0.09)mmol/L、β2-MG(12.62±3.34)mg/L及PTH(337.96±142.80)pg/ml也优于HFHD组,差异有统计学意义(P<0.05),HD+HDF组与HD+HP组相比差异无统计学意义;HD组治疗前后血P、Ca×P、PTH、β2-MG水平差异无统计学意义。4组治疗前后血钙水平差异无统计学意义。结论 HFHD组、HD+HDF组、HD+HP组在清除血P、PTH及β2-MG上优于HD组,尤其HD+HDF组、HD+HP组更优。

Objective To compare the effects of different purification methods on elements related to rental osteopathy. Methods Sixty-four patients who had undergone blood purification for six months and had been diagnosed with rental osteopathy at our center were randomly and equally divided into four groups： HD group, HFHD （once a week） group, HD ＋ HDF（onee a week） group and HD ＋ HP（onee a week） group to compare the changes in the levels of Ca,P, PTH, ALP and β2-MG in each group before treat- ment and 24 weeks after treatment. Calcium-phosphorus product （ Ca x P） was also calculated. Results After treatment, levels of P, ALP,PTH,β2-MG and the product of Ca x P（P 〈0.05） in the HFHD group HD ＋ HDF group and HD ＋ HP group were significantly decreased. The ability to clean up P（ 1.91 ± 0.19 ） mmol/L, β2-MG（ 11.32 ± 2.61 ） mg/L and PTH （ 347.21 ± 152.05 ） pg/ml in the HD ＋ HDF group was improved compared to P（ 1.98 ± 0.41 ） mmol/L, β2-MG （ 17.09 ± 5.06） mg/L and PTH （471.98 ± 123.02 ） pg/ ml in the HFHD group. Furthermore, the same ability of the HD ＋ HP group was better than that of the HFHD group（ P 〈 0.05 ）. How-ever, there was no significant difference between HD ＋ HDF group and HD ＋ HP group. Meanwhile, the levels of P,Ca x P,PTH and 62-MG in HD group did not decrease after treatment. The level of Ca remained unchanged after treatment. Conclusions P, PTH and β2-MG in the HFHD group, HD ＋ HDF group and HD ＋ HP group can be better cleaned up than in the HD group.