高通量血液透析联合罗盖全对尿毒症患者钙磷代谢紊乱及微炎症状态的影响

目的：探讨高通量血液透析联合罗盖全对尿毒症患者钙磷代谢紊乱及微炎症状态的影响。方法选择2012年04月至2014年10月于南京医科大学附属江宁医院行规律血液透析的尿毒症患者70例。将70例尿毒症患者按随机数表法分为观察组35例(高通量血液透析联合罗盖全)和对照组35例(常规血液透析联合罗盖全)，随访12个月，观察两组患者治疗前和治疗12个月后的血钙、血磷、甲状旁腺素(PTH)、β2微球蛋白(β2-MG)及炎症因子超敏C反应蛋白(hs-CRP)、白介素(IL-6)、肿瘤坏死因子(TNF)-α、脂蛋白Lp(a)]的变化，比较两组患者心脏瓣膜钙化的患病率。结果治疗12个月后，观察组脱失5例，完成30例，对照组脱失4例，完成31例。观察组患者治疗12个月后的血磷(1.60±0.15) mmol/L vs (1.23±0.17) mmol/L]、PTH (68.9±4.73) nmol/L vs (30.26±3.10) nmol/L]、β2-MG水平(24.26±7.14) mg/L vs (10.40±3.65) mg/L ]均显著低于对照组，差异均有显著统计学意义(P<0.01)，而两组患者的血钙水平比较差异无统计学意义(P>0.05)；观察组患者的炎症因子hs-CRP (15.48±5.86) mg/L vs (5.17±2.63) mg/L]、IL-6(151.97±48.16) ng/L vs (82.42±27.40) ng/L]、TNF-α(1.65±0.92) ng/L vs (0.86±0.24) ng/L]、Lp(a)(486.75±380.42) mg/L vs (237.38±157.42) mg/L]水平均显著低于对照组，差异均有显著统计学意义(P<0.01)；观察组患者的心脏瓣膜钙化患病率为26.67%，显著低于对照组的54.83%，差异有显著统计学意义(P<0.01)。结论高通量血液透析联合罗盖全能够更有效的清除血磷、PTH、β2-MG及炎症因子，降低心脏瓣膜钙化患病率，其疗效优于普通血液透析联合罗盖全治疗。

Effect of high-flux hemodialysis combined with Rocaltrol on calcium and phosphorus metabolism disturbances and micro-inflammatory state in patients with uremia

Objective To explore the effect of high-flux hemodialysis combined with Rocaltrol on calcium and phosphorus metabolism disturbances and micro-inflammatory state in patients with uremia. Methods A total of 70 cas-es of patients with uremia, who admitted to Jiangning Hospital Affiliated to Nanjing Medical University and underwent hemodialysis from April 2012 to October 2014, were divided into the observation group (high-flux hemodialysis com-bined with Rocaltrol, n=35) and control group (conventional hemodialysis with Rocaltrol, n=35) according to random number table method. Following up for 12 months, the level of serum calcium, serum phosphorus, parathyroid hormone (PTH),β2-microglobulin (β2-MG) and inflammatory factors including high-sensitivity C-reactive protein (hs-CRP), inter-leukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α), lipoprotein(a) (Lp(a)) in the two groups were measured before and after 12 months of treatment, and the prevalence of two groups of patients with heart valve calcification was com-pared. Results After 12 months of treatment, the observation group lost 5 cases and completed 30 cases;The control group lost 4 cases and completed 31 cases. The levels of serum phosphorus, PTH,β2-MG in the observation group were (1.60±0.15) mmol/L, (68.9±4.73) nmol/L, (24.26±7.14) mg/L, respectively, which were significantly lower than those in the control group of (1.23±0.17) mmol/L, (30.26±3.10) nmol/L, (10.40±3.65) mg/L, respectively, all with P<0.01. How-ever, there was no significant difference between the two groups in the blood calcium level (P>0.05). The levels of hs-CRP, IL-6, TNF-α, Lp(a) in the observation group were (15.48±5.86) mg/L, (151.97±48.16) ng/L, (1.65±0.92) ng/L, (486.75±380.42) mg/L, respectively, which were significantly lower than those in the control group of (5.17±2.63) mg/L, (82.42±27.40) ng/L, (0.86±0.24) ng/L, (237.38±157.42) mg/L, respectively, P<0.01. The prevalence of heart valve calci-fication in the observation group (26.67%) was significantly lower than that in the control group of 54.83%,χ2=6.4524, P<0.01. Conclusion The high-flux hemodialysis combined with Rocaltrol can be more effective in removing blood phosphorus, PTH,β2-MG and inflammatory factor, and reducing the incidence of cardiac valve calcification. The cura-tive effect of high-flux hemodialysis combined with Rocaltrol is superior to conventional hemodialysis with Rocaltrol.