不同血液净化方法对尿毒症患者甲状旁腺素水平的影响

目的比较联机血液透析滤过（HDF）和常规血液透析（HD）对尿毒症患者甲状旁腺素（iPTH）水平的影响。方法选择我院血液净化中心2004年6月至2006年12月期间透析龄超过9个月且iPTH明显升高的尿毒症患者60例，其中男38例、女22例，平均年龄43．5岁，平均透析龄（18．6±9．3）月。将患者随机分为HDF组和HD组，每组30例。两组患者每周均透析三次，HDF组为1次HDF、2次HD，每次透析4h。HDF组使用F60滤过器；HD组使用F6HPS透析器，统一低分子肝素抗凝。检测透析前后患者血液血肌酐（SCr）、血尿素氮（BUN）及iPTH水平并计算其清除百分率。结果SCr与BUN清除率在HD组分别为（70.6％±3．2％）和（74．2%±4．0％），在HDF组分别为（71．8％±2．3％）和（76．2%±3．8％），两组之间差异无统计学意义。HD组血iPTH值透析前后无显著差异，清除率仅为（1．7%±0．9%），而HDF组iPTH的清除率为（32．8％±7．8％），该组透析前后溶质浓度及清除率的差异均有统计学意义。结论两种血液净化治疗方式对小分子物质的清除效果无差异，但HDF对中分子物质（iPTH）的清除效果明显优于HD。定期HDF有利于iPTH的清除、防止iPTH异常导致的钙磷代谢紊乱、降低代谢性骨病等并发症的发生率。

Effect of hemodiafiltration vs hemodialysis on parathyroid hormone levels of patients with uremia

Objective To compare the effects of hemodiafiltration （HDF） vs hemodialysis （HD） on the parathyroid hormone（iPTH） levels in the patients with uremia. Method Sixty patients with uremia, including 38 males and 22 females, with average age of 43.5 years, average dialysis duration of （18. 6 ± 9. 3 months） and increased iPTH levels, were selected from our blood purification center from during 2004 to December 2006. The patients were randomly divided into 2 groups： HDF group and HD group （n = 30 in each group） cases for each one. All of them had dialysis 3 times every week, 4 h every time. The patients in HDF group received HDF one time and HD two times. Low molecular weight heparin was used for anticoagulation for all the patients. The blood SCr, BUN and iPTH levels were measured before and after dialysis and the clearance percentage was calculated at the same time. Result The clearance rate of SCr and BUN in HD group was （70. 6% ± 3.2%） and （74. 2% ± 4.0%）, and that in HDF group was （71.8% ± 2. 3%） and （76.2% ± 3.8%）, respectively, with the difference being not significant （P〉0.05）. The clearance rate of blood iPTH had no significant difference in liD group before and after dialysis （1.7%±0.9%）, and in the HDF group, it was（32.8%±7.8%） with the difference in the solute concentration and clearance rate before and after dialysis being statistically significant （P〈0.05）. Conclusion The two kinds of blood purification treatments were basically similar in clearance of small molecular substances. But to the middle molecular substance, HDF was superior to HID. Therefore, regular HDF would be benefit to the clearance of iPTH, prevent the iPTH abnormality-induced the disturbance of metabolism of calcium and phosphatesm and reduce the occurrence of complications such as metabolic bone diseases.