血液灌流联合血液透析对肾衰竭伴钙磷代谢异常患者的影响

Effect of Hemoperfusion Combined with Hemodialysis on Renal Failure Patients with Abnormal Calcium and Phosphorus Metabolism

目的:探讨血液灌流联合血液透析对肾衰竭伴钙磷代谢异常患者的影响。方法:选择龙岩市博爱医院2021年1月—2022年1月收治的91例肾衰竭伴钙磷代谢异常患者,按照随机数表法分为A组(n=46)和B组(n=45),B组予以血液透析治疗,A组在B组基础上予以血液灌流治疗,观察两组肾功能指标[β_(2)-微球蛋白(β_(2)-MG)、血肌酐(Scr)、尿酸(UA)]、钙磷代谢水平、甲状旁腺素(PTH)水平及炎症反应[超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]。结果:治疗前,两组β_(2)-MG、Scr、UA水平比较,差异无统计学意义(P>0.05);治疗3个月后,两组β_(2)-MG、Scr、UA水平均较治疗前降低,且A组低于B组,差异有统计学意义(P<0.05)。治疗前,两组血钙、血磷水平比较,差异无统计学意义(P>0.05);治疗3个月后,两组血钙水平较治疗前升高,血磷水平较治疗前降低,且A组血钙水平高于B组,血磷水平低于B组,差异有统计学意义(P<0.05)。A组血钙达标率(80.43%)、血磷达标率(65.22%)高于B组(55.56%、40.00%),差异有统计学意义(P<0.05)。治疗前,两组PTH水平比较,差异无统计学意义(P>0.05);治疗3个月后,两组PTH水平均较治疗前降低,且A组低于B组,差异有统计学意义(P<0.05)。A组PTH达标率(52.17%)高于B组(26.68%),差异有统计学意义(P<0.05)。治疗前,两组hs-CRP、IL-6、TNF-α水平比较,差异无统计学意义(P>0.05),治疗3个月后,两组hs-CRP、IL-6、TNF-α水平均较治疗前降低,且A组低于B组,差异有统计学意义(P<0.05)。结论:血液灌流联合血液透析有助于改善肾衰竭伴钙磷代谢异常患者的肾功能,维持钙磷代谢平衡,降低PTH水平,减轻炎症反应。

Objective:To investigate the effect of hemoperfusion combined with hemodialysis on renal failure patients with abnormal calcium and phosphorus metabolism.Method:A total of 91 patients with renal failure associated with calcium and phosphorus metabolism admitted in Longyan Bo’ai Hospital from January 2021 to January 2022,and they were divided into the group A(n=46)and group B(n=45)according to random number table.Group B was treated with hemodialysis,while group A was treated with hemoperfusion on the basis of group B.The renal function indexes of the two groups[β_(2)-microglobulin(β_(2)-MG),serum creatinine(Scr),uric acid(UA)],calcium and phosphorus metabolism level,parathyroid hormone(PTH)level and inflammatory response[hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)]were observed.Result:Before treatment,there were no significant differences in the levels ofβ_(2)-MG,Scr and UA between the two groups(P>0.05);after 3 months of treatment,the levels ofβ_(2)-MG,Scr and UA in the two groups were lower than those before treatment,and the indexes in group A were lower than those in the group B,the differences were statistically significant(P<0.05).Before treatment,there were no significant differences between the two groups in blood calcium and phosphorus levels(P>0.05);after 3 months of treatment,the blood calcium levels of the two groups were higher than those before treatment,and the blood phosphorus levels were lower than those before treatment,and the blood calcium level of group A was higher than that of group B,and the blood phosphorus level was lower than that of group B,the differences were statistically significant(P<0.05).The rate of reaching the standard of blood calcium(80.43%)and blood phosphorus(65.22%)in group A were higher than those in group B(55.56%,40.00%),the differences were statistically significant(P<0.05).Before treatment,there was no significant difference in PTH level between the two groups(P>0.05);after 3 months of treatment,the PTH levels in both groups were lower than those before treatment,and the level in group A was lower than group B,the differences were statistically significant(P<0.05).The PTH reaching rate in group A(52.17%)was higher than that in group B(26.68%),the difference was statistically significant(P<0.05).Before treatment,there were no significant differences in hs-CRP,IL-6,TNF-αlevels between the two groups(P>0.05);after 3 months of treatment,the levels of hs-CRP,IL-6,TNF-αin the two groups were lower than those before treatment,and the levels in group A were lower than those in group B,and the differences were statistically significant(P<0.05).Conclusion:Hemoperfusion combined with hemodialysis can help improve the renal function of patients with renal failure and abnormal calcium and phosphorus metabolism,maintain the balance of calcium and phosphorus metabolism,reduce the level of PTH,and reduce inflammation.