高通量血液透析联合血液灌流治疗高转运肾性骨营养不良临床观察

【目的】观察高通量血液透析联合血液灌流治疗维持性血液透析患者高转运型肾性骨营养不良的疗效。【方法】42例伴高转运性肾性骨营养不良的血液透析患者随机分为对照组（n=21）和观察组（n=21）,对照组给予常规血液透析治疗,观察组给予高通量血液透析联合血液灌流治疗,3个月后评估两组患者临床症状：肌肉酸痛、骨痛、关节炎和肩周炎症状、皮肤瘙痒等;监测生化指标：肌酐（creatinine,Cr）、尿素氮（blood urea nitrogen,BUN）、钙（calcium,Ca2＋）、磷（phosphorus,P3-）、β2微球蛋白（β2-microglobulin,β2-MG）、甲状旁腺激素（intact parathyroid hormone,iPTH）、骨钙素（bone GLA protein,BGP）。【结果】观察组与对照组以及治疗前比较：临床症状显著改善;P3-、β2-MG、iPTH、BGP等生化指标显著下降,有统计学意义（P〈0.05）。【结论】高通量血液透析联合血液灌流能通过有效清除MHD患者体内大、中分子毒素,控制和改善尿毒症患者高转运性肾性骨营养不良症状,疗效确切。

Clinical observation of high-flux hemodialysis combined with hemoperfusion on high turnover renal osteodystrophy

[Objective] To observe the effect of high-flux hemodialysis combined with hemoperfusion in treatment of maintenance hemodialysis patients with high transfer type of renal osteodystrophy effect. [Methods] 42 cases with high transportes in renal osteodystrophy in hemodialysis patients were randomly divided into control group （n = 21） and observation group （n = 21）, the control group was given conventional hemodialysis treatment, the observation group was given high-flux hemodialysis combined with hemoperfusion in treatment. After treatment of 3 months, the two groups of patients with clinical symptoms was assessed incluing muscle soreness, pain ar- thritis and scapulohumeral periarthritis, skin itching and other symptoms; the biochemical indexes was monitored incluing creatinine （Cr）, blood urea nitrogen （BUN）, calcium （Ca2＋）, phosphorus （p^3-）, β 2 Microglobulin protein （ β 2-MG）, intact parathyroid hormone （iPTH）, bone gla protein （BGP）. [ Results] In the observation group and the control group and before treatment： clinical symptoms improved significantly, p^3-, β 2-MG, iPTH, BGP and other biochemical index decreased significantly, with statistical significance（P 〈 0.05）. [ Conclusion ] High flux hemodialysis combined with hemoperfusion can effectively remove MHD in patients with large, middle molecular weight toxins, control and improvement in uremic patients in high transporters renal osteodystrophy symptoms, curative effect.