血液透析联合血液灌流治疗慢性肾衰竭伴继发甲状旁腺功能亢进研究

Hemodialysis along with hemoperfusion in the treatment of chronic renal failure and secondary hyperparathyroidism

目的探究血液透析联合血液灌流对慢性肾衰竭伴继发甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)患者的治疗作用以及对患者残肾功能的影响。方法选取2017年2~12月,上海市松江区中心医院收治的慢性肾衰竭继发甲状旁腺功能亢进患者64例,根据治疗方法分为对照组与观察组,每组32例。对照组患者给予单纯血液透析治疗,观察组给予血液透析联合血液灌流。对比两组患者治疗效果和残余肾功能。结果观察组总有效率为96.88%(31/32),对照组为81.25%(26/32),差异有统计学意义(χ^2=4.010,P=0.045)。透析后观察组收缩压和舒张压均低于对照组,差异有统计学意义(t=6.630、4.697,P=0.000)。透析后,两组患者Ccr(t=4.480,P=0.000),Cr(t=7.757,P=0.000),BUN(t=5.616,P=0.000),kt/V(t=3.385,P=0.000)差异有统计学意义。透析后,两组患者Hcy(t=7.053,P=0.000)、PTH(t=15.763,P=0.000)及β2-MG(t=12.034,P=0.000)水平差异有统计学意义。结论血液透析联合血液灌流治疗,能够更好保护患者残余肾功能,能更全面地清除毒素,进而改善微炎症状态。

Objective To evaluate the clinical effect of Hemodialysis(HD) along with hemoperfusion(HP) in the treatment of chronic renal failure and secondary hyperparathyroidism. Methods 64 patients with chronic renal failure and secondary hyperparathyroidism admitted in Shanghai Songjian Central Hospital from February 2017 to December 2017 were enrolled and divided into observation group(n=32) and control group(n=32).Patients in control group were treated with only HD, while those in observation group were treated with HD along with HP, and the therapeutic effect and residual renal function were evaluated and compared between the two groups. Results The total effective rate was significantly higher among patients in observation group than those in control group(96.88% vs 81.25%;χ^2=4.010, P=0.045).After the dialysis, both diastolic and systolic blood pressures were significantly lower among cases in observation group than that of controls(t=6.630,4.697,P=0.000).Meanwhile, there were statistically significant differences in Ccr, Cr, BUN, Kt/V as well as in Hcy, PTH and β2-MG between the two groups(t=4.480,7.757,5.616,3.385,7.053,15.763,12.034,P=0.000). Conclusions HD along with HP can effectively protect the residual renal function and comprehensively remove toxins and further improve the state of micro-inflammation of patients with chronic renal failure and secondary hyperparathyroidism.