不同血液净化方式对原发性肾小球肾炎患者慢性肾脏病-矿物质和骨异常治疗的影响

Effects of different blood purification methods on chronic kidney disease-mineral and bone abnormalities in patients with primary glomerulonephritis

目的:探讨不同血液净化方式对原发性肾小球肾炎(primary glomerulonephritis,PGN)患者慢性肾脏病-矿物质和骨异常(chronic kidney disease-mineral and bone abnormalities,CKD-MBD)治疗的影响。方法:选取2020年1月至2022年2月于万宁市人民医院接受治疗的116例PGN患者为研究对象。根据随机数字表法分为对照组(n=58)、观察组(n=58)。对照组实施血液透析滤过(hemodiafiltration,HDF),观察组实施血液灌流(hemoperfusion,HP)联合血液透析(hemodialysis,HD)。比较2组临床效果与治疗前后血清钙、磷、全段甲状旁腺激素(intact parathyroid hormone,iPTH)、骨碱性磷酸酶(bone alkaline phosphatase,BALP)、骨保护素(osteoprotegerin,OPG)、核因子-κB受体活化因子配体(receptor activator of nuclear factor-κB ligand,RANKL)、OPG/RANKL水平与并发症发生情况。结果:2组治疗后90d的临床总有效率比较差异无统计学意义(P>0.05);2组血清钙指标的水平升高,而磷、iPTH指标降低(均P<0.05),观察组血清钙指标高于对照组,而磷、iPTH指标低于对照组(均P<0.05);2组血清BALP、RANKL指标降低,而OPG、OPG/RANKL水平均升高(均P<0.05),观察组血清BALP、RANKL指标低于对照组,而OPG、OPG/RANKL指标高于对照组(均P<0.05);观察组头痛及并发症总发生率高于对照组(P<0.05)。结论:HDF、HP联合HD两种方案一定程度上均能提高PGN患者CKD-MBD治疗效果,但HP联合HD更能改善PGN患者血钙、磷等矿物质及骨代谢指标水平,而HDF并发症风险相对较低,在临床实际治疗中仍需结合患者具体病情酌情选择血液净化方案。

Objective:To investigate the effect of different hemopurification methods on the treatment of chronic kidney disease-mineral and bone abnormalities(CKD-MBD)in patients with primary glomerulonephritis(PGN).Methods:A total of 116 PGN patients who were treated in the Wanning People’s Hospital from January 2020 to February 2022 were selected as the research objects.According to the random number table method,they were divided into a control group(n=58)and an observation group(n=58).The control group received hemodiafiltration(HDF),and the observation group received hemoperfusion(HP)combined with hemodialysis(HD).The clinical effects,serum levels of Ca,P,intact parathyroid hormone(iPTH),bone alkaline phosphatase(BALP),osteoprotegerin(OPG),receptor activator of nuclear factor-κB ligand(RANKL),OPG/RANKL,and complications before and after treatment were compared between the 2 groups.Results:There was no significant difference in the total clinical effective rate between the 2 groups(P>0.05)at 90 days after treatment;serum Ca indexes in the 2 groups increased whereas P and iPTH indexes decreased(all P<0.05).The serum Ca index in the observation group was higher than that in the control group,whereas the P and iPTH indexes were lower than those in the control group(all P<0.05).Serum BALP and RANKL indexes decreased whereas the OPG and OPG/RANKL indexes increased in both groups(all P<0.05).The serum BALP and RANKL indexes in the observation group were lower than those in the control group,whereas the indexes of OPG and OPG/RANKL in the observation group were higher than those in the control group(all P<0.05).The total incidence of headache and complications in the observation group was higher than that in the control group(P<0.05).Conclusion:Both HDF and HP combined with HD can improve the therapeutic effect of CKD-MBD in PGN patients to a certain extent,but HP combined with HD can better improve the levels of blood Ca,P and other mineral and bone metabolic indexes in PGN patients,while the risk of complications of HDF is relatively low.In the actual clinical treatment,hemopurification programs should still be selected according to the specific conditions of patients.