血液透析滤过串联血液灌流治疗SHPT疗效分析

Efficacy of hemodiafiltration combined with hemoperfusion in the treatment of secondary hyperparathyroidism

目的观察血液透析滤过串联血液灌流治疗维持性血液透析(MHD)患者并发继发性甲状旁腺功能亢进症(SHPT)的疗效。方法采取前瞻性队列研究,选取安徽理工大学第一附属医院血液净化中心2021年2月至2023年3月收治的MHD并发SHPT患者40例,采取随机数字表法分为对照组20例、观察组20例。对照组接受单一的高通量血液透析,观察组采用血液透析滤过和血液灌流相结合的方法,两组透析3个月。比较两组患者透析前后血红蛋白(Hb)、血尿素氮(BUN)、血肌酐(SCr)、血清钙(Ca^(2+))、血磷(P^(3+))、甲状旁腺激素(PTH)的变化。结果透析后,观察组Hb为(119.45±5.27)g/L,高于对照组的(106.30±6.52)g/L(t=-7.02,P<0.001),P3+为(1.18±0.17)mmol/L,低于对照组的(1.52±0.22)mmol/L(t=5.49,P<0.001),PTH为(122.14±40.57)ng/L,低于对照组的(168.78±78.27)ng/L(t=2.39,P=0.023)。结论运用血液透析滤过联合血液灌流治疗,可以减轻MHD并发SHPT患者的临床症状,升高Hb,降低P^(3+)、PTH,值得在临床中推广。

Objective To investigate the efficacy of hemodiafiltration combined with hemoperfusion in the treatment of secondary hyperparathyroidism(SHPT)in patients undergoing maintenance hemodialysis(MHD).Methods A total of 40 patients with SHPT undergoing MHD who received treatment at the Blood Purification Center of The First Affiliated Hospital of Anhui University of Science and Technology from February 2021 to March 2023 were included in this prospective cohort study.They were randomly divided into a control group and an observation group(n=20/group).The control group received a single high flux hemodialysis,while the observation group used a combination of hemodialysis filtration and hemoperfusion for 3 months.In both groups,the changes in hemoglobin,blood urea nitrogen,serum creatinine,serum calcium,serum phosphorus,and parathyroid hormone levels were compared before and after dialysis.Results After dialysis,the hemoglobin level in the observation group was(119.45±5.27)g/L,which was significantly higher than(106.30±6.52)g/L in the control group(t=-7.02,P<0.001).The serum phosphorus level in the observation group was(1.18±0.17)mmol/L,which was significantly lower than(1.52±0.22)mmol/L in the control group(t=5.49,P<0.001).The parathyroid hormone level in the observation group was(122.14±40.57)ng/L,which was significantly lower than(168.78±78.27)ng/L in the control group(t=2.39,P=0.023).Conclusion Hemodiafiltration combined with hemoperfusion can reduce clinical symptoms,increase hemoglobin level,and reduce phosphorus and parathyroid hormone levels in patients with SHPT undergoing MHD,which deserves clinical promotion.