血液灌流串联血液透析滤过对血液透析患者矿物质与骨异常的影响

Effect of hemoperfusion combined with hemodiafiltration onmineral and bone disorder in hemodialysis patients

目的探讨血液灌流(HP)串联血液透析滤过(HDF)对血液透析慢性肾脏病患者矿物质与骨异常(CKD-MBD)的影响。方法选择2018年10月至2020年2月在我院行维持性血液透析治疗的CKD-MBD患者92例,采用随机数字法分为两组,每组46例。在常规治疗的基础上,对照组患者给予单纯血液透析(HD)治疗,观察组患者在HD治疗的基础上给予HP串联HDF治疗,疗程3个月。比较两组患者治疗前后的血钙、血磷、全段甲状旁腺激素(iPTH)、Ⅰ型前胶原氨基端前肽(PINP)、Ⅰ型胶原羟基端肽β降解产物(β-CTX)、尿酸(UA)、血尿素氮(BUN)、血肌酐(Scr)水平。结果治疗前,两组患者的血钙、血磷及iPTH水平比较,差异无统计学意义(P>0.05);治疗3个月后,观察组患者的血磷及iPTH水平明显低于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者的PINP、β-CTX水平比较,差异无统计学意义(P>0.05);治疗3个月后,观察组患者的PINP、β-CTX水平均显著低于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者的UA、BUN及Scr水平比较,差异无统计学意义(P>0.05);治疗3个月后,观察组患者的UA、BUN及Scr水平均显著低于对照组,差异有统计学意义(P<0.05)。结论血液灌流串联血液透析滤过可有效清除维持性血液透析CKD-MBD患者机体内的大中分子毒素,纠正矿物质与骨代谢紊乱状况,有利于改善患者预后。

Objective To explore the effect of hemoperfusion(HP)and hemodiafiltration(HDF)on chronic kidney disease mineral and bone disorder(CKD-MBD)in hemodialysis patients.Methods A total of 92 patients with MBD who underwent maintenance hemodialysis in our hospital from October 2018 to February 2020 were selected,and they were divided into two groups by the random number method,with 46 cases in each group.On the basis of conventional treatment,patients in the control group were given simple hemodialysis(HD)for treatment,based on which patients in the observation group were given HP combined with HDF for treatment,with a three-month treatment course.The blood calcium,blood phosphorus,intact parathyroid hormone(iPTH),procollagen typeⅠN-terminal propeptide(PINP),C-terminal cross-linking telopeptide of typeⅠcollagen(β-CTX),uric acid(UA),blood urea nitrogen(BUN),blood creatinine(Scr)levels before and after treatment were compared between the two groups.Results Before treatment,there were no statistically significant differences in blood calcium,blood phosphorus and iPTH levels between the two groups(P>0.05).After 3 months of treatment,the blood phosphorus and iPTH levels of the observation group were significantly lower than those of the control group,with statistically significant differences(P<0.05).Before treatment,there were no statistically significant differences in the levels of PINP andβ-CTX between the two groups(P>0.05).After 3 months of treatment,the levels of PINP andβ-CTX in the observation group were significantly lower than those in the control group,with statistically significant differences(P<0.05).Before treatment,there were no statistically significant differences in the levels of UA,BUN and Scr between the two groups(P>0.05).After 3 months of treatment,the levels of UA,BUN and Scr in the observation group were significantly lower than those in the control group,with statistically significant differences(P<0.05).Conclusion HP combined with HDF can effectively remove large and medium molecular toxins in CKD-MBD patients with maintenance hemodialysis,correct mineral and bone metabolism disorders,and help to improve the prognosis of patients.