血液透析滤过联合血液灌流治疗尿毒症继发甲状旁腺功能亢进的临床效果

Clinical effect of hemodiafiltration combined with hemoperfusion in the treatment of uremia secondary hyperparathyroidism

目的探讨血液透析滤过联合血液灌流治疗尿毒症继发甲状旁腺功能亢进的临床效果。方法选取2014年7月~2018年6月我院收治的87例尿毒症继发甲状旁腺功能亢进患者作为研究对象,应用随机数字表法将其分为对照组(43例)与观察组(44例)。对照组患者采取常规血液透析滤过治疗,观察组患者在对照组的基础上联合血液灌流治疗。比较两组患者的临床治疗效果、治疗费用、治疗前后小分子毒素指标[血钙(Ca)、血磷(P)、钙磷乘积、血尿素氮(BUN)、血清肌酐(SCr)]、大分子毒素指标[甲状旁腺激素(iPHT)、胱抑素C(CysC)、β2微球蛋白(β2-MG)]水平。结果观察组患者的治疗费用为(8.93±2.75)万元,明显高于对照组的(7.15±1.61)万元,差异有统计学意义(P<0.05)。两组患者治疗前的小分子毒素指标水平比较,差异无统计学意义(P>0.05);两组患者治疗后的P、SCr、钙磷乘积、BUN水平均低于治疗前,Ca水平均高于治疗前,差异有统计学意义(P<0.05);观察组患者治疗后的P、SCr、钙磷乘积、BUN、Ca水平均低于对照组,差异有统计学意义(P<0.05)。两组患者治疗前的大分子毒素指标水平比较,差异无统计学意义(P>0.05);两组患者治疗后的iPHT、CysC、β2-MG水平均低于治疗前,差异有统计学意义(P<0.05);观察组患者治疗后的iPHT、CysC、β2-MG水平均低于对照组,差异有统计学意义(P<0.05)。观察组患者的治疗总有效率为95.45%,高于对照组的81.40%,差异有统计学意义(P<0.05)。结论血液透析滤过联合血液灌流治疗尿毒症继发甲状旁腺功能亢进的效果显著,能够切实改善患者的临床症状及指标,提升患者预后及生活质量。

Objective To investigate the clinical effect of hemodiafiltration combined with hemoperfusion in the treatment of uremia secondary to hyperparathyroidism. Methods Eighty-seven patients with uremia secondary hyperparathyroidism admitted to our hospital from July 2014 to June 2018 were enrolled in the study. They were divided into the control group (43 cases) and the observation group (44 cases) according to the random number table method. The patients in the control group were treated with routine hemodiafiltration, and the patients in the observation group were treated with hemoperfusion on the basis of the control group. The clinical treatment effect, treatment cost, levels of small molecule toxin indexes (blood calcium [Ca], blood phosphorus [P], calcium and phosphorus product, blood urea nitrogen [BUN], serum creatinine [SCr]), and large molecular toxin indexes (parathyroid hormone [iPHT], cystatin C [CysC],β2 microglobulin [β2-MG]) before and after treatment were compared in the two groups. Results The treatment cost of the observation group was (8.93±2.75)×104 yuan, which was significantly higher than that of the control group for (7.15±1.61)×104 yuan, and the difference was statistically significant (P<0.05). There were no significant differences in the levels of small molecule toxin indexes between the two groups before treatment (P>0.05). The levels of P, SCr, calcium and phosphorus product and BUN in the two groups after treatment were lower than those before treatment, the Ca level was higher than that before treatment, and the differences were statistically significant (P<0.05). The levels of P, SCr, calcium and phosphorus product, BUN and Ca in the observation group after treatment were lower than those in the control group, and the differences were statistically significant (P<0.05). There were no significant differences in the levels of large molecule toxin indexes between the two groups before treatment (P>0.05). The levels of iPHT, CysC and β2-MG in the two groups after treatment were lower than those before treatment, and the differences were statistically significant (P<0.05). The levels of iPHT, CysC and β2-MG in the observation group after treatment were lower than those in the control group, and the differences were statistically significant (P<0.05). The total effective rate of treatment in the observation group was 95.45%, which was higher than that in the control group accounting for 81.40%, and the difference was statistically significant (P<0.05). Conclusion Hemodiafiltration combined with hemoperfusion is significant in the treatment of uremia secondary to hyperparathyroidism, which can effectively improve the clinical symptoms and indicators of patients, improve their prognosis and quality of life.