不同血液净化方式联合骨化三醇冲击治疗对维持性血液透析患者肾性骨病指标的影响及意义

目的 通过观察不同血液净化方式联合骨化三醇冲击治疗对维持性血液透析患者肾性骨病指标的影响,探讨肾性骨病合适的治疗方案.方法 将60例符合标准的患者按随机数字表法分为3组,每组20例.所有患者采用骨化三醇冲击治疗,使用低钙透析液.普通透析组患者采用常规透析,血液透析滤过组患者采用血液透析滤过治疗,每周透析3次,其中血液透析滤过治疗每周1次.血液透析灌流组患者采用血液透析联合血液灌流治疗,每周透析3次,其中血液透析联合血液灌流治疗每周1次.结果 3组患者使用不同透析方式联合药物治疗3个月后发现,治疗前3组患者血钙、血磷、血甲状旁腺激素水平比较差异无统计学意义(P＞0.05),治疗后1个月血液透析灌流组患者血磷与普通透析组患者比较差异有统计学意义(P＜0.05),而血液透析滤过组患者的血磷与普通透析组比较差异无统计学意义(P＞0.05)；治疗后3个月血液透析滤过组和血液透析组患者的血甲状旁腺激素、血磷、血钙水平与普通透析组比较差异也有统计学意义(P＜0.05),而血液透析滤过组和血液透析灌流组间血甲状旁腺激素、血磷、血钙水平比较差异无统计学意义(P＞0.05).结论 对于维持性血液透析的患者存在高磷血症以及继发性甲状旁腺激素的升高等肾性骨病的指标异常,可以应用血液透析滤过以及血液透析联合血液灌流治疗,且安全可行.

Different kinds of blood purification with implosive therapy of calcitriol for influence of renal osteopathy index of maintenance hemodialysis patients

Objective TO observe different kinds of blood purification with implosive therapy of calcitriol for influence of Renal Osteopathy index of Maintenance hemodialysis (MHD) patients,discuss the appropriate treatment for Renal Osteopathy.Methods 60 patients who were according with the standard divided into three groups randomly,20 patients each group,implosive therapy of calcitriol,using low calcium dialysate,the A group using conventional dialysis,the B group using the treatment of HDF,3 times each week which was consisted of once HDF.The C group using the treatment of HD + HP,3 times each week which was consisted of once HD + HP.Results After 3 months,treatment,No significant differences in Ca,P,Ca× P,PTH in before treatment of A,B or C group( P ＞ 0.05),1 month later,C and A group,which of blood P declined obviously( P ＜ 0.05),there were no significant differences between B and A group ( P ＞0.05).3 months later,B and A group,which of blood P,Ca× P,PTH declined obviously( P ＜0.05).there were no significant differences between B and C group ( P ＞ 0.05).Conclusions MHD patients who were existed abnormal index of Renal Osteopathy such as hyperphosphataemia and high secondary hyperparathyroidism could be treated by HDF and HD + HP,which were secure and feasible.