腹膜透析和血液透析对尿毒症患者钙磷代谢影响的临床研究

目的探讨血液透析与腹膜透析对尿毒症患者在钙、磷代谢的影响。方法对97例血液透析及45例腹膜透析治疗均超过3个月以上的患者在0、3、6个月进行血钙、磷及全段甲状旁腺激素测定和比较,并记录患者的残余尿量。入选后2组高甲状旁腺激素患者使用骨化三醇治疗,血液透析高钙患者采用1.25mmol/L的钙浓度的透析液进行治疗。结果治疗初血液透析组的高血磷、高甲状旁腺激素和低甲状旁腺激素发生率分别为51.5%、37.1%、8.2%,而腹膜透析组分别为22.2%、17.8%、24.4%,经比较2组有统计学差异。两组患者尿量大于500ml的腹膜透析组占有55.6%、血液透析组6.2%,经比较2组有统计学意义。在使用低钙透析液及罗盖全治疗后3、6月,血液透析组和腹膜透析组患者的甲状旁腺激素均较治疗前明显减少,F值分别为23.803和4.9896,P<0.05,差异有统计学意义,血液透析组中的血钙较治疗前明显下降,F值为19.879,P<0.05,差异有统计学意义。结论相对于血液透析,尿毒症患者选择腹膜透析能更好地控制钙磷代谢,能更有效地保护残肾功能。关注透析患者的饮食,以及重视低钙透析液,骨化三醇在透析患者钙磷代谢中的治疗。

Clinical study on calcium-phosphorous metabolism in uremic patients on peritoneal dialysis or hemodialysis

Objective To observe the changes of calcium-phosphorous metabolism in patients with peritoneal dialysis or hemodialysis.Methods Serum calcium,phosphorus and parathyroid hormone（PTH） were measured in 45 peritoneal dialysis and 97 hemodialysis patients after the treatments for 0,3,and 6 months.Their residual urine output was recorded.Patients with higher PTH were treated with calcitriol,and were treated with low calcium（1.25 μmol/l） dialysate for hemodialysis patients.Results At the beginning of the treatments,the prevalence rate of hyperphosphatemia,higher PTH,and lower PTH was 51.5%,37.1% and 8.2%,respectively,in hemodialysis group,and was 22.2%,17.8% and 24.4%,respectively,in peritoneal dialysis group,and the residual urine output 500 ml/day was found in 6.2% patients in hemodialysis group,and in 55.6% patients in peritoneal dialysis group,significantly different between the two groups.In hemodialysis and peritoneal dialysis groups,serum PTH decreased after the treatment with calcitriol and low calcium dialysate for 3 and 6 months（F=23.803 and 4.9896,respectively,P0.05）.In hemodialysis group,serum calcium was lower than that before the treatment（F=19.879,P0.05）.Conclusion For uremic patients,peritoneal dialysis was better than hemodialysis in maintenance of normal calcium phosphorus metabolism and protection of residual renal function.Appropriate diet,low calcium dialysate,and calcitriol therapy should be considered for improvement of calcium-phosphorus metabolism in dialysis patients.