血液透析联合血液灌流清除维持性血液透析患者成纤维细胞生长因子23的疗效观察

Clearance effect of hemodialysis combined with hemoperfusion on serum fibroblast growth factor-23 in maintenance hemodialysis patients

目的:比较传统血液透析(hemodialysis,HD)和HD联合血液灌流(hemoperfusion,HP)对维持性血液透析(maintenance hemodialysis,MHD)患者外周血成纤维细胞生长因子23(fibroblast growth factor-23,FGF-23)的清除效果。方法:选择2016年1月至6月上海市嘉定区中心医院血液净化中心收治的MHD患者,随机分为HD组和HD联合HP(HD+HP)组,各30例。HD组:每周3次,每次4h。HD+HP组:每周HD 2次,每次4h;HP联合HD 1次,每次2h;单独HD 2h。两组治疗周期均为6个月。分别测定并记录两组患者在治疗开始及治疗周期结束时的血红蛋白(Hb)、血清白蛋白(Alb)、FGF-23、血清磷(P)、钙(Ca)、尿素氮(BUN)、血肌酐(Scr)及甲状旁腺激素(iPTH)等水平。结果:治疗前两组患者间Hb、Alb、BUN、Scr、Ca、P、iPTH、FGF-23差异均无统计学意义。治疗6个月后,两组患者BUN、Scr均较治疗前降低(P<0.05),HD+HP组患者血P、iPTH、FGF-23较治疗前降低(P<0.05)。治疗后两组患者间血P、iPTH、FGF-23差异均有统计学意义(P<0.05),Hb、Alb、BUN、Scr差异无统计学意义。结论:HD联合HP治疗模式安全有效;与传统HD相比,HD联合HP治疗模式可有效降低MHD患者血清P、iPTH、FGF-23水平。

Objective：To compare the clearance effect on serum fibroblast growth factor-23（FGF-23）between traditional hemodialysis（HD）and HD combined with hemoperfusion（HP）.Methods：Totally 60 maintenance hemodialysis（MHD）patients from January 2016 to June 2016 in Central Hospital of Jiading District in Shanghai were randomly divided into HD group（30 cases）and HD＋HP group（30 cases）.The patients in HD group underwent HD（3 times/week,4 h/time）,the patients in HD＋HP group underwent HD（2 times/week,4 h/time）,HD combined with HP（1 time/week,2 h/time）then change into HD for 2 h.The treatment lasted for 6 months.The data of serum phosphorus（P）,calcium（Ca）,urea nitrogen（BUN）,creatinine（Scr）,intact parathyroid hormone（iPTH）,FGF-23 levels were collected before and after study.Results：There were no significantly differences of BUN,Scr,Ca,P,iPTH,FGF-23 between HD group and HD＋HP group at the beginning of study.After 6 months treatment,the levels of BUN and Scr were significantly decreased（all P〈0.05）in both groups.The levels of P,iPTH,and FGF-23 were significantly decreased after treatment in HD＋HP group（all P〈0.05）.The levels of P,iPTH,and FGF-23 in HD＋HP group were significantly lower than those in HD group（P〈0.05）at the end of study,and no significantly differences of Hb,Alb,BUN,Scr were found between groups.Conclusions：Compared with HD,HD combined with HP treatment can significantly reduce the levels of P,iPTH,and FGF-23 in serum of MHD patients.