帕立骨化醇联合血液透析滤过治疗糖尿病肾病慢性肾衰竭的疗效及其对骨代谢指标的影响

Efficacy of Paricalcitol Combined with Hemodiafiltration in the Treatment of Chronic Renal Failure with Diabetic Nephropathy and Its Effect on Bone Metabolism Indexes

目的 探讨帕立骨化醇联合血液透析滤过治疗糖尿病肾病慢性肾衰竭的疗效及其对骨代谢指标的影响。方法 选取2020年4月至2021年4月在本院确诊的90例糖尿病肾病慢性肾衰竭患者,采用简单随机分组将患者分为观察组和对照组,各45例,对照组采用血液透析滤过治疗,观察组帕立骨化醇联合血液透析滤过治疗,均持续治疗8周。分别于治疗前后,测定患者血肌酐(SCr)、尿酸(UA)、尿氮素(BUN)、血磷、血钙、I型原胶原N端前肽(PINP)和全段甲状旁腺激素(iPTH)水平,并记录两组患者恶心呕吐、食欲降低、静脉炎和胃肠道反应等不良反应的发生情况。结果 观察组治疗的有效率为93.33%,明显高于对照组77.78%有效率(χ^(2)=4.406,P=0.036)。治疗后,观察组UA、SCr、BUN、血磷、PINP和iPTH水平明显低于对照组,而血钙水平明显高于对照组(P<0.05)。治疗期间两组患者出现恶心呕吐、食欲降低、静脉炎和胃肠道反应等不良反应无明显差异(P>0.05)。结论 帕立骨化醇联合血液透析滤过治疗糖尿病肾病慢性肾衰竭可以明显提高临床疗效,降低肾功能指标,改善患者骨代谢,且安全性较好。

Objective To investigate the efficacy of paricalcitol combined with hemodiafiltration in the treatment of chronic renal failure with diabetic nephropathy and its effect on bone metabolism indexes.Methods A total of 90 patients with diabetic nephropathy and chronic renal failure who were diagnosed in our hospital from April 2020 to April 2021 were selected. The patients were divided into an observation group and a control group by simple random grouping, 45 cases in each group. The control group was treated with hemodiafiltration.the observation group was treated with paricalcitol combined with hemodiafiltration for 8 weeks. Before and after treatment, serum creatinine(SCr), uric acid(UA), urea nitrogen(BUN), serum phosphorus, serum calcium, type I procollagen N-terminal propeptide(PINP) and full-segment parathyroid hormone( iPTH) level, and the occurrence of adverse reactions such as nausea and vomiting, decreased appetite, phlebitis and gastrointestinal reactions in the two groups were recorded.Results The effective rate of treatment in the observation group was 93.33%, which was significantly higher than the total effective rate of 77.78% in the control group(χ^(2)=4.406,P=0.036). After treatment, the levels of UA, SCr, BUN, serum phosphorus, PINP and iPTH in the observation group were significantly lower than those in the control group, while the levels of serum calcium were significantly higher than those in the control group(P<0.05). During the treatment period, there was no significant difference in the probability of nausea and vomiting, decreased appetite, phlebitis and gastrointestinal reactions in the two groups(P>0.05).Conclusion Paricalcitol combined with hemodiafiltration in the treatment of chronic renal failure with diabetic nephropathy can significantly improve clinical efficacy, reduce renal function indexes, and improve bone metabolism in patients with good safety.