复方α-酮酸片联合血液透析滤过治疗CKD-MBD及其生存危险因素分析

The effect of compoundα-ketoacid tablet combined with hemodiafiltration in the treatment of CKD-MBD patients and the analysis of risk factors for survival

目的探讨复方α-酮酸片联合血液透析滤过(HDF)治疗慢性肾脏病矿物质和骨异常(CKD-MBD)的效果,并分析影响其生存率的危险因素。方法选取96例CKD-MBD患者分为两组,HDF组(n=48)接受HDF治疗,联合治疗组(n=48)接受复方α-酮酸片联合HDF治疗,比较两组临床疗效、矿物质和骨代谢指标、不良反应、生存状况,并分析影响生存率的危险因素。结果联合治疗组临床疗效高于HDF组(P<0.05)。治疗后联合治疗组血清磷、甲状旁腺素、骨保护素、成纤维细胞生长因子-23、骨碱性磷酸酶水平低于HDF组(P<0.05)。联合治疗组不良反应总发生率显著低于HDF组(P<0.05)。Kaplan-Meier生存曲线显示,联合治疗组3年生存率高于HDF组(P<0.05);多因素Cox回归分析显示,查尔森合并症指数(CCI)、前白蛋白、白蛋白为CKD-MBD患者生存危险因素(P<0.05)。结论复方α-酮酸片联合HDF治疗CKD-MBD疗效确切,CCI≥5、前白蛋白、白蛋白为其生存危险因素。

Aim To investigate the effect of compoundα-ketoacid tablet combined with hemodiafiltration(HDF)in the treatment of chronic kidney disease-mineral and bone abnormalities(CKD-MBD)patients,and analyze risk factors affecting the survival rate of patients.Methods A total of 96 CKD-MBD patients were divided into two groups.The HDF group(n=48)received HDF treatment,and the combined treatment group(n=48)received compoundα-keto acid tablets combined with HDF treatment.The clinical efficacy,mineral and bone metabolism indexes,adverse reactions,and survival status of the two groups were compared,and the risk factors affecting survival rate were analyzed.Results The clinical efficacy of the combined treatment group was significantly higher than that of the HDF group(P<0.05).After treatment,the serum phosphorus(P),parathyroid hormone(PTH),osteoprotegerin(OPG),fibroblast growth factor-23(FGF-23),and bone alkaline phosphatase(BALP)levels in the combined treatment group were significantly lower than those in the HDF group(P<0.05).The total incidence of adverse reactions in the combined treatment group was significantly lower than that in the HDF group(P<0.05).Kaplan-Meier survival curve showed that the 3-year survival rate of the combined treatment group was significantly higher than that of the HDF group(P<0.05).Multivariate Cox regression analysis showed that Chalson's Complication Index(CCI),prealbumin(PA),and albumin(ALB)were risk factors for the survival rate of CKD-MBD patients(P<0.05).Conclusions Compoundα-ketoacid tablets combined with HDF have a definite effect in the treatment of CKD-MBD.CCI≥5,PA and ALB are risk factors for survival.