组合人工肾结合药物治疗维持性血液透析患者继发性甲状旁腺功能亢进的临床研究

Clinical Study on the Treatment of Secondary Hyperparathyroidism in Maintenance Hemodialysis Patients with Combined Artificial Kidney and Drugs

目的:探讨应用组合型人工肾联合西那卡塞、帕立骨化醇治疗维持性血液透析患者继发性甲状旁腺功能亢进症的临床疗效。方法:选取2019年6月1日-2021年1月1日茂名市人民医院150例血液透析继发性甲状旁腺功能亢进症患者作为研究对象,随机分为A、B、C三组,各50例。A组行常规血液透析;B组使用组合型人工肾,通过对血液透析器及血液灌流器进行串联;C组用组合型人工肾,并联用帕立骨化醇及西那卡塞药物治疗。在治疗前和治疗后6个月,分别留取两组血清标本,并检测血清Ca、P及iPTH水平。此外观察患者疗效及并发症,通过调查问卷方式,评估患者治疗前和治疗后6个月生活质量评分的改善情况。结果:C组治疗后的血清Ca、P及iPTH水平明显低于A组、B组,C组治疗总有效率高于A组、B组,并发症发生率低于A组、B组,差异均有统计学意义(P<0.01)。三组KDQOL-36评分在治疗后均有所提高,C组治疗后KDQOL-36评分显著高于A组和B组(P<0.01)。结论:组合型人工肾联合西那卡塞、帕立骨化醇治疗维持性血液透析患者继发性甲状旁腺功能亢进症能提高有效率并降低并发症发生率,并显著改善患者的生活质量。

Objective:To investigate the clinical efficacy of combined artificial kidney combined with Cinacalcet and Paricalcitol in the treatment of secondary hyperparathyroidism in maintenance hemodialysis patients.Method:A total of 150 secondary hyperparathyroidism in maintenance hemodialysis patients in Maoming People’s Hospital from June 1,2019 to January 1,2021 were selected as the research objects and randomly divided into three groups:group A,group B and group C,with 50 cases in each group.Group A received routine hemodialysis;group B was treated with combined artificial kidney,which was connected in series by dialysis apparatus and perfusion apparatus;group C was treated with combined artificial kidney,and Paricalcitol and Cinacalcet.Serum samples were collected before and 6 months after treatment,and serum levels of Ca,P and iPTH were detected.In addition,the efficacy and complications were observed,and the improvement of quality of life scores before and 6 months after treatment was evaluated by questionnaire.Result:After treatment,the serum Ca,P and iPTH levels in group C were significantly lower than those in groups A and B,the total effective rate in group C was higher than that in groups A and B,and the incidence of complications in group C was lower than that in groups A and B,and the differences were statistically significant (P<0.01).The KDQOL-36 score of the three groups was improved after treatment,and the KDQOL-36 score of group C was significantly higher than that of groups A and B (P<0.01).Conclusion:Combined artificial kidney combined with Cinacalcet and Paricalcitol in the treatment of secondary hyperparathyroidism in maintenance hemodialysis patients can increase the effective rate and reduce the incidence of complications,and significantly improve the quality of life of patients.