不同血液透析方式对尿毒症患者钙磷代谢影响的研究

Effects of different hemodialysis methods on calcium and phosphorus metabolism in uremia patients

目的 观察不同血液透析方式对尿毒症患者钙磷代谢影响的临床研究.方法 选择行维持性血液透析患者130例,根据透析方式不同分为维持性血液透析组（HD组）以及维持性血液透析滤过组（HDF组）,各65例.HD组采用维持性血液透析.HDF组使用高通量聚砜膜透析器,两组患者均透析6个月.观察两组血磷下降程度的短期疗效,评价两组治疗前后血钙（Ca^2＋）、血磷（P^3＋）、甲状旁腺激素（iPTH）、1,25二羟基维生素D[1,25（OH）2D]各项指标水平变化.结果 HD组总有效率为76.92％,HDF组总有效率为84.62％,两组差异无统计学意义（χ^2=1.250,P=0.535）;治疗后,两组Ca^2＋较治疗前升高,均显著高于治疗前（t=4.841,P=0.00;t=8.600,P=0.00）,且HDF组高于HD组（t=4.41,P=0.00）;治疗后,两组P^3＋较治疗前下降,均显著低于治疗前（t=14.580,P=0.00;t=19.260,P=0.00）,HDF组低于HD组（t=6.500,P=0.00）;治疗后,两组iPTH较治疗前下降,均显著低于治疗前（t=58.800,P=0.00;t=65.730,P=0.00）,且HDF组低于HD组（t=8.380,P=0.00）;治疗后,两组1,25（OH）2D较治疗前升高,均显著高于治疗前（t=18.970,P=0.00;t=21.650,P=0.00）,且HDF组高于HD组（t=3.250,P=0.001）.结论 维持性血液透析滤过组相比较维持性血液透析对尿毒症患者钙磷代谢具有更积极影响,降低血磷疗效显著,升高血钙水平,因此较适合临床推广使用.

Objective To observe the effect of different hemodialysis methods on calcium and phosphorus metabolism in uremic patients .Methods 130 patients with uremia who underwent hemodialysis were divided into maintenance hemodialysis group （ HD group ） and maintenance hemodialysis filtration group （ HDF group ） according to different dialysis methods ,65 cases in each group .The HD group was treated with maintenance hemodialysis .The HDF group received high -throughput polysulfone membrane dialyzer ,the two groups received dialysis for 6 months. The Ca^2＋,serum phosphorus （P^3＋）,parathyroid hormone （iPTH）,1,25 dihydroxyvitamin D[1,25（OH）2D] were measured before and after treatment in both two groups .Results The total effective rate was 76.92% in the HD group and 84.62%in the HDF group.There was no statistically significant difference between the two groups （χ^2 =1.25,P=0.535）.After treatment,Ca^2＋in the two groups was statistically significantly increased compared with before treatment（t=4.841,P=0.00;t=8.600,P=0.00）,and Ca^2＋in the HDF group was higher than that in the HD group （t=4.410,P=0.00）.After treatment,P^3＋in the two groups was significantly decreased compared with before treatment（t=14.580,P=0.00;t=19.260,P=0.00）,and P^3＋in the HDF group was lower than that in the HD group（t=6.500,P=0.00）.After treatment,iPTH in the two groups was significantly decreased compared with before treatment（t=58.800,P=0.00;t=65.730,P=0.00）,and iPTH in the HDF group was significantly lower than that in the HD group （t=8.380,P=0.00）.After treatment,the 1,25（OH）2D levels in the two groups were significantly higher than those before treatment （t=18.970,P=0.00;t=21.650,P=0.00）,and 1,25（OH）2D level in HDF group was significantly higher than HD group （t=3.250,P=0.001）.Conclusion Compared with maintenance hemodialysis , maintenance hemodialysis filtration has more positive effect on calcium and phosphorus metabolism in uremic patients ,and it has significant effect on lowering blood phosphorus and increasing serum calcium level,so it is more suitable for clinical use .