血液灌流串联血液透析滤过改善肾性骨营养不良效果研究

【目的】比较血液灌流(hemoperfusion,HP)串联血液透析滤过(hemodiafiltration,HDF)、血液灌流(HP)串联血液透析(hemodialysis,HD)与常规血液透析(HD)对改善肾性骨营养不良的疗效。【方法】将慢性肾脏病(chronic kidney disease,CKD)5期患者90例随机分为三组,A组常规血液透析治疗(HD)组30例;B组血液灌流串联血液透析组(HP+HD)30例,C组血液灌流串联血液透析滤过组(HP+HDF)30例。分别于首次治疗前后测定三组患者的瘦素、甲状旁腺素(parathyroid hormone,PTH)、骨碱性磷酸酶(bonealk aline phosphatase,BALP)、骨钙素(osteocalcin,OC)、骨钙蛋白(bone gla protein,BGP)Scr、BUN、Ca2+、P3+、首次治疗后左室射血分数(left ventricular ejection fraction,LVEF)及甲状旁腺超声检查的水平,连续治疗8周后同法检测,进行统计学分析。【结果】A组患者治疗前后清除瘦素、甲状旁腺素等差异均无统计学意义(P>0.05);B组、C组不管是首次治疗前后还是8周后治疗前与首次治疗前比较均有统计学意义(P<0.05)。C组患者两种物质的清除率明显高于A组、B组,P<0.05有统计学意义。【结论】血液灌流串联血液透析滤过能有效改善肾性骨营养不良。

Studies on the effects of improving renal osteodystrophy in patiens undergoing hemoperfusion combined with hemodiafiltration

[Objective]To compare the effects of improving hemoperfusion（HP） combined with hemodiafiltration（HDF）, hemoperfusion （HP） combined with hemodialysis（HD） and conventional hemodialysis（HD） in the treatment of renal osteodystrophy（ROD ）. [ Methods] the clinical data of 90 patients with chronic kidney disease（CKD ） stage 5 were divided randomly into groups A,B and C 30 in each, groups A： conventional hemodialysis（HD）; groups B hemoperfusion （HP） combined with hemodialysis（HD） ; groups C： hemoperfusion （HP） combined with hemodiafihration（HDF）. To compare the concentration of serum Leptin, parathyroid hormone（PTH）,bone alkaline phosphatase（BALP）, osteocalein（OC）, benegla protein（BGP）,serum ereatinine（Scr）,blood urea nitrogen（ BUN）,ealcium（Ca2＋）,phosphorus （p3＋） were detected in 3 groups before and after treatment, 8 weeks after treatment. To compare the level of left ventricular ejection fraction（LVEF） and color doppler ultrasound of parathyroid were detected in 3 groups after treatment, 8 weeks after treatment. The results were determind to analyze the correlation between the indexes. [ Results ] There was not significant difference in leptin and parathyroid hormone etc in groups A between before and after treatment（P 〉 0.05）. Leptin and parathyroid hormone etc levels decreased remarkably in group B and group C, when compared with before and after the first time of treatment, and between the first time of treatment and the last time of treatment（P 〈 0.05）. The level of cleanrance for serum leptin and serum parathyroid hormone, in groups C were significantly higher than those in group A and group B （P 〈 0.05）. [Conclusion] The hemoperfusion（HP）combined with hemodiafiltration（HDF） can improve the effects of renal osteodystrophy.