血液透析联合血液灌流对尿毒症继发甲状旁腺功能亢进的疗效

Effect of hemodialysis combined with hemoperfusion on secondary hyperparathyroidism in uremia

目的探讨血液透析联合血液灌流对尿毒症继发甲状旁腺功能亢进患者疗效及血清甲状旁腺激素(PTH)、钙磷乘积水平的影响。方法选择2013年11月至2016年11月诊治的尿毒症继发甲状旁腺功能亢进患者86例,依照抽签法分为两组,各43例。对照组采取血液透析治疗,观察组采取血液透析联合血液灌流治疗,均连续治疗6个月。对比两组入院时、治疗6个月后血清PTH、血肌酐(Scr)、尿素氮(BUN)、钙、磷、钙磷乘积水平及生活质量评分(SF-36),并观察比较两组疗效。结果入院时两组血清PTH、Scr、BUN及钙、磷、钙磷乘积水平、生活质量评分比较差异均无统计学意义(P均>0.05)。治疗6个月后评价:(1)两组血清PTH、Scr、BUN水平均降低(P均<0.01),且观察组PTH、Scr、BUN水平均低于对照组(P均<0.01);(2)两组血清磷、钙磷乘积水平降低(P均<0.01),血清钙水平升高(P<0.01),且观察组血清磷和钙磷乘积水平[(34.84±5.29)mg^2/dl^2vs(41.27±6.14)mg^2/dl^2]低于对照组(P均<0.01),血清钙水平高于对照组(P<0.01);(3)两组SF-36评分均提高(P均<0.01),且观察组高于对照组(P<0.01);(4)观察组显效26例,有效12例,无效5例,对照组显效18例,有效11例,无效14例,观察组疗效明显优于对照组(Z=1.985,P=0.047)。结论尿毒症继发甲状旁腺功能亢进患者给予血液透析联合血液灌流治疗,可有效清除患者体内毒素,降低其血清PTH、钙磷乘积水平,缓解临床症状,改善生活质量,疗效优于单纯血液透析治疗。

Objective To investigate the effects of hemodialysis combined with hemoperfusion on the treatment of secondary hyperparathyroidism,serum parathyroid hormone（ PTH）,calcium-phosphorus product level in patients with uremia. Methods A total of 86 patients with secondary hyperparathyroidism in uremia from November 2013 to November 2016 were selected and divided into control group and observation group according to the drawing method（ n = 43,each）.The patients were treated with hemodialysis in control group and treated with hemodialysis combined with hemoperfusion in observation group for 6 months. The serum levels of PTH,serum creatinine（ Scr）,urea nitrogen（ BUN）,calcium,phosphorus,calcium-phosphorus product levels and quality of life by SF-36 health questionnaire were compared at admission and 6 months after treatment between two groups. Results There were no significant differences in the levels of PTH,Scr,BUN and calcium-phosphorus product on admission between two groups（ all P〉0. 05）. At 6 months after treatment,the results showed：（ 1） the serum levels of PTH,Scr and BUN significantly increased in both two groups（ all P〈0. 01） and were significantly lower in observation group than those in control group（ all P〈0. 01）;（ 2） the level of serum phosphorus,calcium-phosphorus product[（ 34. 84 ± 5. 29） mg^2/dl^2 vs（ 41. 27 ± 6. 14） mg^2/dl^2] decreased in both two groups and were significantly lower in observation group than those in control group（ all P〈0. 01）. The serum level of calcium increased in both two groups and was statistically higher in observation group than that in control group（ P〈0. 01）;（ 3） SF-36 score significantly increased in both two groups（ all P〈0. 01） and was higher in observation group than that in control group（ P〈0. 01）;（ 4） there were 26 cases markedly effective,12 cases effective,5 cases invalidin observation group and 18-,11-and 14-cases respectively in control group. The curative effect in observation group was significantly better than that in control group（ Z = 1. 985,P = 0. 047）. Conclusion Hemodialysis combined with hemoperfusion can effectively eliminate the toxins in patients,reduce the levels of serum PTH,calcium-phosphorus products,relieve the clinical symptoms and improve the quality of life in the treatment of secondary hyperthyroidism in uremia,and the curative effect is better than that of hemodialysis alone.