血液透析联合血液灌流对骨化三醇冲击治疗继发性甲旁亢的效果分析

The Effect of Hemodialysis Combined with Hemoperfusion on the Treatment of Secondary Hyperthyroidism with Calcitriol

目的观察血液透析(HD)联合血液灌流(HP)对继发甲状旁腺功能亢进(SHPT)患者应用骨化三醇冲击治疗的效果及不良反应。方法观察血液灌流及无血液灌流治疗前、后血钙(Ca^2+)、血磷(P^3-)、钙磷乘积、甲状旁腺素(iPTH)的变化,并记录患者皮肤瘙痒、骨痛、贫血等临床不良症状改善情况。结果两组患者Ca^2+及iPTH的检测值均在治疗4周后存在明显变化,对照组P^3-在治疗4周后存在明显变化,而实验组P^3-在治疗8周后与治疗前存在明显差异。治疗8周后,实验组P^3-与iPTH值的下降速度明显快于对照组,12周后,两组患者的Ca^2+、P^3-、Ca×P、iPTH差异均存在统计学意义。治疗后两组患者皮肤瘙痒、骨痛、贫血等临床症状均有改善,但实验组皮肤瘙痒的患者明显少于对照组。结论HD联合HP能够快速降低骨化三醇治疗SHPT后血iPTH和P^3-,并有效降低血清Ca^2+的增高幅度,对改善贫血、减轻骨痛、皮肤瘙痒作用明显。

Objective To observe the effect and adverse reactions of hemodialysis combined with hemoperfusion on the treatment of secondary hyperthyroidism with calcitriol. Methods Changes of Ca^2+,P^3-,Ca×P and iPTH before and after the treatment were observed in the blood perfusion group and the group without blood perfusion,and the clinical symptoms of pruritus,bone pain and anemia were recorded. Results The values of Ca^2+ and iPTH in the two groups showed significant changes after 4 cycles of treatment,P^3- in the control group showed significant changes after 4 cycles,and P^3- in the experimental group showed significant differences after 8 cycles,compared with level of pre-treatment.After 8 weeks of treatment,the decrease rates of P^3- and iPTH values in the experimental group were significantly faster than that in the control group.After the treatment,the clinical symptoms of pruritus,osteodynia and anemia in the two groups were improved,but the number of patients with pruritus in the experimental group was significantly lower than that in the control group. Conclusion HD combined with HP can rapidly reduce iPTH and P^3- in patient blood after the treatment of SHPT by calcitriol,and effectively reduce the increase rate of Ca^2+,which has significant effects on improving anemia,relieving bone pain and pruritus.