高通量血液透析对老年终末期肾病患者钙磷代谢紊乱、继发性甲状旁腺功能亢进与透析充分性的影响

Effect of high flux hemodialysis on calcium-phosphorus metabolism disturbances, secondary hyperparathyroidism and dialysis adequacy in elderly patients with end-stage renal disease

目的探讨高通量血液透析(high flux hemodialysis,HFHD)对老年终末期肾病(end-stage renal disease,ESRD)患者钙磷代谢紊乱、继发性甲状旁腺功能亢进与透析充分性的影响。方法选择2016年1月至2016年12月于本院首次拟行血液透析(hemodialysis,HD)治疗的86例老年ESRD患者为研究对象,采用随机数表法分为观察组和对照组,每组各43例。观察组、对照组患者分别给予常规HD、HFHD治疗[超滤系数分别为50 ml/(h·mm Hg)与9.8 ml/(h·mm Hg)],比较两组患者透析前后的钙磷代谢水平、甲状旁腺功能及透析充分性。结果透析6、12个月后,观察组患者的血磷、血清全段甲状旁腺激素(intact parathyroid hormone,i PTH)与β_2微球蛋白(β_2 microglobulin,β_2-MG)水平均显著低于本组透析前及同期对照组(P_均<0.05),其总变化率均显著高于对照组(P_均<0.05)。对照组患者透析12个月后的血磷与i PTH水平均显著低于透析前(P_均<0.05)。结论与常规HD相比,HFHD能显著提高对老年ESRD患者血磷的清除效果,更好地纠正钙磷代谢紊乱和继发性甲状旁腺功能亢进,且透析充分性更强。

Objective To investigate the effect of high flux hemodialysis（HFHD） on calcium-phosphorus metabolism disturbances, secondary hyperparathyroidism and dialysis adequacy in elderly patients with end-stage renal disease（ESRD）. Method 86 elderly patients with ESRD who prepared hemodialysis（HD） in our hospital from January 2016 to December 2016 were enrolled and randomly divided into the observation group and control group, each group with 43 cases. Patients in observation group and control group were treated with routine HD and HFHD respectively, ultrafiltration coefficient were 50 ml/（h·mm Hg） and 9.8 ml/（h·mm Hg） respectively. The calcium-phosphorus metabolism, parathyroid function and dialysis adequacy were compared between the two groups before and after dialysis. Result Blood levels of phosphorus, intact parathyroid hormone（i PTH） and β2 microglobulin（β2-MG） levels in observation group at 6, 12 months after dialysis were significantly lower than those before dialysis and those in control group at the same period（P〈0.05）, and their total change rates were significantly higher than that in control group（P〈0.05）, and blood levels of phosphorus and i PTH in control group at 12 months after dialysis were significantly lower than that before dialysis（P〈0.05）. Conclusion Compared with routine HD, HFHD could significantly improve the scavenging effect of blood phosphorus in elderly patients with ESRD, rectify calcium-phosphorus metabolism disturbances and secondary hyperparathyroidism, and had greaterdialysis adequacy.