血液透析联合血液灌流对维持性血液透析患者钙磷代谢的影响

Influences of hemodialysis combined with hemoperfusion on calcium and phosphorus metabolism in patients with maintenance hemodialysis

目的探讨血液透析联合血液灌流对维持性血液透析(MHD)患者钙磷代谢、微炎症状态及营养水平的影响,为临床治疗提供参考。方法 70例尿毒症MHD患者按数字表法分为对照组35例(实施常规血液透析治疗)与观察组35例(实施血液透析联合血液灌流治疗)。观察两组患者治疗前及治疗3个月后的血钙、血磷、钙磷乘积、血清甲状旁腺激素的变化、微炎症状态、营养水平及皮肤瘙痒症状的改善情况。结果治疗3个月后,观察组、对照组患者治疗后肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)均较治疗前有所下降,血红蛋白(Hb)、血浆白蛋白(ALB)较治疗前均有所上升,差异均有统计学意义(t分别=6.04、10.90、8.29、3.67、4.90、5.22;18.54、6.70、9.18、3.09,P均<0.05),且治疗后的观察组各项指标水平均明显优于对照组(t分别=4.45、9.33、8.30、11.34、4.65,P均<0.05)。治疗3个月后,观察组血钙水平较治疗前明显升高,而血磷、钙磷乘积、血清甲状旁腺激素(i PTH)较治疗前均明显下降,差异均有统计学意义(t分别=4.24、3.86、3.58、12.73,P均<0.05);对照组治疗3个月后血钙水平、i PTH较治疗前有所改善(t分别=2.96、3.11,P均<0.05),而血磷、钙磷乘积改善不明显(t分别=0.70、0.84,P均>0.05)。治疗后,观察组钙、磷、钙磷乘积及i PTH改善水平明显优于对照组(t分别=2.87、4.49、7.36、10.80,P均<0.05)。观察组患者皮肤瘙痒症状的缓解率(86.67%)明显高于对照组(50.00%),差异具有统计学意义(χ2=28.14,P<0.05)。结论血液透析联合血液灌流可有效降低MHD患者血磷、钙磷乘积及i PTH水平,纠正钙磷代谢紊乱,还可有效改善患者微炎症状态、营养水平及皮肤瘙痒症状。

Objective To investigate the effects of hemodialysis combined with hemoperfusion on calcium and phosphorus metabolism,micro inflammatory state and nutritional status in patients with maintenance hemodialysis（MHD）,and to provide reference for clinical treatment. Methods A total of 70 patients with uremic MHD were divided into the control group who received routine hemodialysis and the observation group who received hemodialysis combined with hemoperfusion,35 cases in each. The blood calcium,phosphorus,calcium and phosphorus products,serum parathyroid hormone changes,micro inflammatory state,nutritional level and pruritus symptoms in two groups before and after treatment for 3 months were observed. Results Three months after treatment,the TNF-α and hs-CRP,IL-6 of the observation group and the control group were decreased compared with before treatment,while the levels of Hb and ALB were increased,the differences were statistically significant（t=6.04,10.90,8.29,3.67,4.90,5.22,18.54,6.70,9.18,3.09,P〈0.05）. The levels of the TNF-α,hs-CRP,IL-6,Hb and ALB of the observation group after treatment were significantly better than the control group（t=4.45,9.33,8.30,11.34,4.65,P〈0.05）. Three months after treatment,the serum calcium level of the observation group were increased compared with before treatment,while the levels of serum phosphorus,calcium phosphorus product and i PTH were decreased,the differences were statistically significant（t=4.24,3.86,3.58,12.73,P〈0.05）. The levels of blood calcium and i PTH of the control group before treatment were improved（t=2.96,3.11,P〈0.05）,while the serum phosphorus,calcium and phosphorus product were not significantly improved（t=0.70,0.84,P〈0.05）. The levels of the product of calcium,phosphorus,calcium and phosphorus and i PTH of the observation group after treatment were significantly better than the control group（t=2.87,4.49,7.36,10.80,P〈0.05）. The remission rate of the skin pruritus（86.67%）in the observation group was significantly higher than that of the control group（50.00%）,and the difference was statistically significant（χ2=28.14,P〈0.05）. Conclusion Hemodialysis combined with hemoperfusion can effectively reduce the levels of serum phosphorus,calcium phosphorus products and i PTH in patients with MHD,correct the disorder of calcium and phosphorus metabolism,and improve the micro inflammatory state,nutritional level and pruritus symptom.