高通量血液透析对维持性血液透析患者钙磷代谢的影响

Effects on Calcium and Phosphorus Metabolism in High-flux Hemodialysis Patients

目的:探讨常规血液透析(hemodialysis,HD)、高通量血液透析(high-flux hemodialysis,HFHD)、血液透析(HD)+血液透析滤过(hemodiafiltration,HDF)、血液透析(HD)+血液灌流(hemoperfusion,HP)四种不同的透析方式对维持性血液透析(maintenance hemodialysis,MHD)患者钙磷代谢指标的影响,进一步明确HFHD对钙磷代谢的作用。方法:选取2017年7月-2018年12月本院行血液透析的患者200例,依据治疗方法分为四组,每组各50例。治疗6个月后对比血钙(Ca)、血磷(P)、甲状旁腺激素(iPTH)、血清25-羟维生素D3(25-OH-D3)、成纤维细胞生长因子23(FGF23)、β2微球蛋白(β2-MG)的变化情况。结果:治疗6个月后,HD组Ca、P、iPTH、FGF23、25-OH-D3、β2-MG水平与治疗前比较,差异均无统计学意义(P>0.05);HFHD组、HD+HDF组、HD+HP组的P、iPTH、FGF23、β2-MG均较治疗前下降,25-OH-D3较治疗前上升,差异均有统计学意义(P<0.05),各组Ca与治疗前比较差异均无统计学意义(P>0.05)。HFHD组对于P的清除均优于HD+HDF组和HD+HP组(P<0.05),而HD+HDF组和HD+HP组比较,差异无统计学意义(P>0.05);HD+HDF组、HD+HP组对于iPTH、FGF23、β2-MG的清除优于HFHD(P<0.05),而HD+HDF组和HD+HP组比较,差异无统计学意义(P>0.05)。结论:HD难以改善钙磷代谢,HFHD、HD+HDF、HD+HP对P、iPTH、FGF23及β2-MG等中分子物质均能有效的清除,25-OH-D3较治疗前上升,从而改善钙磷代谢紊乱,而HFHD操作简单,值得临床推广。

Objective:To explore the influence of four different dialysis methods on the indexes of Calcium and Phosphorus metabolism in maintenance dialysis patients,including hemodialysis (HD),high-flux hemodialysis (HFHD),hemodialysis+hemodiafiltration (HD+HDF),hemodialysis+hemoperfusion (HD+HP),further clarify the effect of HFHD on calcium and phosphorus metabolism.Method:A total of 200 patients who received regular hemodialysis in our hospital from July 2017 to December 2018 were included.According to the treatment,they were divided into four groups,50 cases in each group.6 months after treatment compared with calcium (Ca),phosphorus (P),parathyroid hormone (iPTH),serum 25-hydroxyl vitamin D3 (25-OH-D3),fibroblast growth factor 23 (FGF23),β2-microglobulin (β2-MG) changes in the situation.Result:After 6 months of treatment,the changes of Ca,P,iPTH,FGF23,25-OH-D3,β2-MG in the HD group were not statistically significant (P>0.05);P,iPTH,FGF23 and β2-MG in the HFHD group,HD+HDF group and HD+HP group decreased compared with those before treatment,25-OH-D3 increased compared with that before treatment,with statistically significant differences (P<0.05),while Ca showed no significant difference compared with that before treatment (P>0.05).The clearance of P in the HFHD group was better than that in the HD+HDF group and the HD+HP group (P<0.05),while there was no significant difference between the HD+HDF group and the HD+HP group (P>0.05).The clearance of iPTH,FGF23 and β2-MG in the HD+HDF group and the HD+HP group were superior to that of HFHD (P<0.05),while there was no significant difference between the HD+HDF group and HD+HP group (P>0.05).Conclusion:HD is difficult to improve Calcium and Phosphorus metabolism.HFHD,HD+HDF,HD+HP can effectively remove medium molecular substances such as P,iPTH,FGF23 and β2-MG,25-OH-D3 is increased compared with that before treatment,thus improving the calcium and phosphorus metabolism disorder,while HFHD is easy to operate,which is worthy of promotion in clinical practice.