不同血液净化方法对患者钙、磷、甲状旁腺激素、营养状态及生活质量的影响

目的探究不同血液净化方法对血液透析患者钙、磷、甲状旁腺激素(iPTH)、营养状态及生活质量的影响。方法前瞻性选取2019年6月至2021年1月汕头市中心医院血液净化中心收治的60例血液净化患者作为研究对象,按随机数表法将患者分为普通血液透析(HD)、透析+血液透析滤过(HD+HDF)、透析+血液灌流(HD+HP),每组各20例。观察3个月,比较3组患者的血钙、血磷、iPTH、营养状态及生活质量改善情况。结果治疗前,3组患者血钙、血磷、iPTH水平比较,差异无统计学意义(P>0.05);治疗后,HD+HDF组血磷较治疗前显著下降,差异有统计学意义(P<0.05);HD+HP组iPTH水平显著低于HD+HDF组及HD组,差异有统计学意义(P<0.05)。治疗前,3组患者的白蛋白、前白蛋白、血红蛋白水平比较,差异无统计学意义(P>0.05);治疗后,HD+HDF组及HD+HP组白蛋白、前白蛋白、血红蛋白水平明显优于HD组,差异均有统计学意义(P<0.05)。治疗前,3组患者各项生活质量评分差异比较,差异无统计学意义(P>0.05);治疗后,HD组改善不明显,HD+HDF及HD+HP组均高于治疗前,且HD+HP组、HD+HDF组高于HD组,差异均有统计学意义(P<0.05)。结论HD+HP及HD+HDF治疗均能够对患者钙磷代谢水平及骨代谢、营养状态起到改善作用,有利于提高生活质量,HD+HDF清除血磷效果最好,HD+HP能有效降低患者iPTH水平,值得临床推广应用。

Effects of different blood purification methods on Ca,P,iPTH,nutritional status and quality of life in hemodialysis patients

Objective To explore the effects of different blood purification methods on calcium(Ca),phosphorus(P),parathyroid hormone(iPTH),nutritional status and quality of life in hemodialysis patients.Methods Sixty hemodialysis patients admitted to the Blood Purification Center of Shantou Central Hospital from June 2019 to January 2021 were prospectively selected as the study subjects and randomly divided into three groups:general hemodialysis(HD),hemodialysis+hemodiafiltration(HD+HDF),and hemodialysis+hemoperfusion(HD+HP),with 20 patients in each group.Observed for three months,the improvement of Ca,P,iPTH,nutritional status and quality of life in the three groups were compared.Results Before treatment,there was no significant difference in serum calcium,serum phosphorus and iPTH levels among the three groups(P>0.05);after treatment,serum phosphorus in HD+HDF group was significantly lower than before treatment,and the difference was statistically significant(P<0.05);the level of iPTH in HD+HP group was significantly lower than that in HD+HDF group and HD group,the difference was statistically significant(P<0.05).Before treatment,there was no significant difference in the levels of albumin,prealbumin and hemoglobin among the three groups(P>0.05);after treatment,the levels of albumin,prealbumin and hemoglobin in HD+HDF group and HD+HP group were significantly better than those in the HD group,and the differences were statistically significant(P<0.05).Before treatment,there were no significant differences in the quality of life scores between the three groups(P>0.05);after treatment,the quality of life scores in HD group were not significantly improved,HD+HDF and HD+HP groups were higher than those before treatment,and HD+HP group and HD+HDF group were higher than those in HD group,the differences were statistically significant(P<0.05).Conclusion Both HD+HP and HD+HDF hemodialysis treatments can improve the level of calcium and phosphorus metabolism,bone metabolism,and nutritional status of patients,and help improve the quality of life.HD+HDF has the best effect in removing blood phosphorus,and HD+HP can be effective Reducing the patient's iPTH level is worthy of clinical application.