组合型人工肾治疗肾性骨病的前瞻性研究

目的 探讨组合型人工肾对尿毒症患者肾性骨病的治疗作用.方法 我院于2008年6月至2009年2月采用血液透析(HD)+血液灌流(HP)方法 治疗30例尿毒症患者(HD+HP组),并与单纯HD治疗尿毒症患者31例(HD组)进行对比研究,通过比较治疗前与治疗后3个月时2组患者的骨痛、皮肤瘙痒、血压、食欲、睡眠等临床症状及尿素氮(BUN)、肌酐(SXr)、血红蛋白(Hb)、血小板(BPC)、钙(Ca)、磷(P)、全段甲状旁腺素(iPTH)等生化指标的变化,客观评价两种方法 治疗尿毒症患者肾性骨病的疗效.结果 HD组、HD+HP组治疗后骨痛的缓解率分别为67.7%(21/31)、96.7%(29/30),皮肤瘙痒的缓解率分别为71.0%(22/31)、96.7%(29/30),HD+HP在缓解维持性透析患者的骨痛与皮肤瘙痒中显著优于单纯HD(P均＜0.01);HD组治疗前后iPTH分别为(65.5±34.4)pmol/L和(57.1±21.4)pmol/L,HD+HP组治疗前后iPTH分别为(73.5±44.4)pmol/L和(19.1±17.4)pmol/L,单纯HD未能很好地清除iPTH(P＞0.05),而HD+HP则可(P＜0.05).结论 对于iPTH水平较高的维持性HD患者,可通过增加HP,达到更好地清除这些患者血中大、中、小分子毒素物质,从而降低肾性骨病发生率,提高其生存质量.

Prospective study of combinative artificial kidney treatment on renal osteopathy

Objective To explore therapeutic effects of combinative artificial kidney treatment on renal osteopathy.Methods HD + HP Group composed by 30 urinaemia was treated with hemodialysis and hemoperfusion,and the HD Group was treated only with hemodialysis.Clinical symptoms and lab indicators including osteodynia,itch of skin,blood pressure,appetite,sleep,as well as BUN,SCr,Hb,BPC,Ca,P and iPTH,were compared between the two groups.Results Osteodynia decreased by 67.7% (21/31),and itch of skin by 71.0% (22/31)in HD group.Osteodynia decreased by 96.7% (29/30) ,and itch of skin by 96.7% (29/30) in HD + HP group (P ＜0.01 ).iPTH were (65.5 ± 34.4) pmol/L before treatment and (57.1 ± 21.4) pmol/L after treatment in HD group,and (73.5 ± 44.4)pmol/L and (19.1 ± 17.4)pmol/L in HD + HP group.HD Group eliminated less iPTH (P ＞0.05).HD + HP Group removed more serum poison molecules than HD Group ( P ＜ 0.05 ).Conclusions For patients in maintenance-dialysis stage but with higher iPTH,hemodialysis combined with hemoperfusion removes more poison molecules,consequently decreases incidence of renal osteopathy.