血液透析联合血液灌流治疗维持性血透患者矿物质及骨代谢异常的临床效果及对钙磷代谢的影响

CLINICAL CURATIVE EFFECT OF HEMODIALYSIS COMBINED WITH HEMOPERFUSION ON CHRONIC KIDNEY DISEASE-MINERAL BONE DISORDER IN PATIENTS UNDERGOING MAINTENANCE HEMODIALYSISAND INFLUENCESONCALCIUM-PHOSPHORUS METABOLISM

目的观察维持性血透患者矿物质及骨代谢异常使用血液透析(hemodialysis,HD)联合血液灌流(hemoperfusion,HP)治疗的临床疗效及其对钙磷代谢指标影响。方法选取2016年10月—2019年11月攀枝花市中医院结合医院收治的HD合并慢性肾脏病矿物质及骨代谢异常(CKD-MBD)患者108例,采用随机数字表法分为观察组和对照组各54例,其中对照组使用HD治疗,观察组使用HD+HP治疗,二组患者均连续治疗6个月。观察二组患者治疗后临床疗效,并比较血磷、血钙、血清全段甲状旁腺激素(intact parathyroid hormone,iPTH)、清护骨素(osteoprotegrin,OPG)、骨碱性磷酸酶(bone alkaline phosphatase,BALP)、骨钙素(bone glaprotein,BGP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、血β2-微球蛋白(β2-microglobulin,β2-MG)、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)水平变化情况。结果观察组治疗后有效率为81.48%,高于对照组的62.69%。二组患者治疗后血磷、血钙、iPTH水平改善均优于治疗前,观察组治疗后血磷、血钙、iPTH水平改善均优于对照组;二组患者治疗后OPG、BALP、BGP水平改善均优于治疗前,观察组治疗后OPG、BALP、BGP水平改善均优于对照组;二组患者治疗后TNF-α、β2-MG、hs-CRP水平改善均优于治疗前,观察组治疗后TNF-α、β2-MG、hs-CRP水平改善均优于对照组,以上所有差异均有统计学意义(均P<0.05)。结论血液透析联合血液灌流治疗慢性肾脏病患者矿物质及骨代谢异常临床疗效较好,能有效改善患者钙磷代谢指标、骨代谢指标,同时调节体内微炎状态,安全性较高。

Objective To investigate the clinical curative effect of hemodialysis(HD)combined with hemoperfusion(HP)on chronic kidney disease-mineral bone disorder(CKD-MBD)in patients undergoing maintenance hemodialysis(MHD) and the influences on calcium-phosphorus metabolism.Methods A total of one hundred and eight patients with HD and CKD-MBD who were admitted to Panzhihua Traditional Chinese Medicine Hospital from October 2016 to November 2019 were enrolled.They were divided into observation group and control group by random number table method, 54 cases in each group.The control group was given HD.The observation group was given HD and HP.Both groups were continuously treated for 6 months.The clinical curative effects of both group after treatment were observed.The changes in levels of blood phosphorus, blood calcium, serum intact parathyroid hormone(iPTH),osteoprotegrin(OPG),bone alkaline phosphatase(BALP),bone glaprotein(BGP),tumor necrosis factor-α(TNF-α),β2-microglobulin(β2-MG) and hypersensitive C-reactive protein(hs-CRP) were compared between the two groups.Results After treatment, the response rate of the observation group washigher than that of the control group(81.48% vs. 62.69%).After treatment, improvement of serum phosphorus, serum calcium and iPTH levels in both groupswas better than that before treatment.After treatment, the improvement of the above indexes in observation group was better than that in control group.After treatment, improvement of OPG,BALP and BGP levels in both groups was better than that before treatment.After treatment, improvement of OPG,BALP and BGP levels in the observation group was better than that in the control group.After treatment, improvement of TNF-α,β2-MG and hs-CRP levels in both groups was better than that before treatment.After treatment, improvement of TNF-α,β2-MG and hs-CRP levels in the observation group was better than that in the control group, all these differences were statistically significant(P<0.05).Conclusion The clinical curative effect of HD combined with HP is relatively better on the patients with CKD-MBD,which can effectively improve calcium-phosphorus metabolism indexes, bone metabolism indexes, while regulating micro-inflammatory status in the body.