高通量血液透析对尿毒症患者血清钙磷代谢及微炎症指标的影响

Effects of High Throughput Hemodialysis on Serum Calcium and Phosphorus Metabolism and Inflammatory Indexes in Patients with Uremia

目的:探讨高通量血液透析(HFHD)对尿毒症患者血清钙磷代谢的影响。方法:66例尿毒症患者均分为对照组和观察组,在常规治疗的基础上,观察组采用HFHD治疗,对照组采用血液透析(HD)治疗,均为3次/周,连续治疗6个月;分别于透析前和透析6个月时,检测2组患者血清甲状旁腺素(i PTH)、钙、磷、血清肿瘤坏死因子-α(TNF-α)及超敏C反应蛋白(hs-CRP)水平,检测患者左室舒张/收缩末期内径(LVEDD/LVESD),计算左室射血分数(LVEF),计算患者透析6个月时血清i PTH、钙及磷的达标率;观察2组透析期间营养不良及各种心血管事件发生率,采用简明健康检查量表(SF-36)评评估患者生活质量。结果:透析前,2组尿毒症患者血清i PTH、钙、磷、TNF-α、hs-CRP水平及LVEDD、LVEDS、LVEF比较,差异无统计学意义(P>0.05);透析6个月时,2组患者血清i PTH、磷、TNF-α及hs-CRP水平较透析前显著降低,观察组降低更明显(P<0.05),血清钙水平无明显变化(P>0.05);透析6个月时,观察组患者血清i PTH、钙及磷的达标率显著高于对照组(P<0.05);与透析前比较,2组LVEDD、LVEDS、LVEF水平仅观察组LVEF升高(P<0.05),其余指标无明显变化(P>0.05);透析期间,观察组营养不良发生率及总不良反应发生率显著低于对照组(P<0.05);透析6个月时,观察组SF-36评分高于对照组(P<0.05)。结论:HFHD可有效降低尿毒症患者血清i PTH、磷及炎性因子水平,改善患者心功能,提高患者生活质量。

Objective： To investigate the effects of high-throughput hemodialysis（ HFHD） on calcium and phosphorus metabolism in patients with uremia. Methods： A total of 66 patients with uremia admitted to our hospital from October 2014 to June 2017 were enrolled and divided into the control group（ n = 33） and the observation group（ n = 33）. On the basis of conventional therapy,the observation group was treated with HFHD,while the control group was treated with hemodialysis（ HD）.Both of the treatment were 3 times per week and the two groups were treated for 6 months. Serum i PTH,levels of calcium,phosphorus,factor-α,hs-CRP,LVEDD and LVESD of patients in the two groups were determined respectively before and after the six-month dialysis. The LVEF and the standard rates of serum i PTH,calcium and phsosphorus were calculated. The incidence of malnutrition and various cardiovascular events during the dialysis were observed and the quality of life was evaluated by SF-36. Results： There was no significant difference in levels of serum i PTH,calcium,phosphorous,TNF-α,hs-CRP and comparisons of LVEDDD,LVEDS and LVEF of patients with uremia in the two groups before dialysis（ P〉0. 05）. After the six-month dialysis,the levels of serum i PTH,TNF-α and hs-CRP of patients in the two groups were significantly lower than those before the dialysis,especially in the observation group（ P〈0. 05）,while there was no significant change in serum calcium level（ P〈0. 05）. Afte the six-month dialysis,the serum IPTHs,calcium and phosphorus levels in the observation group were significantly higher than those in the control group（ P〈0. 05）. Concerning the levels of LVEDD,LVEDS and LVEF,only LVEF in the observation group increased（ P〈0. 05）,and no significant change was found in other indexes（ P〉0. 05）. During the dialysis,the incidence of malnutrition and total adverse reactions in the observation group was significantly lower than that in the control group（ P〈0. 05）,and after the six-month dialysis,the SF-36 score in the observation group was higher than that in the control group（ P〈0. 05）. Conclusions： HFHD can effectively reduce the levels of serum i PTH,phosphorus and inflammatory factors in uremic patients,and improve the heart function and the quality of life of patients.