不同的血液净化方式对维持性血液透析患者血清甲状旁腺激素的影响

目的 探讨不同的血液净化方式对维持性血液透析患者血清甲状旁腺激素的影响，观察皮肤瘙痒、骨关节疼痛、肌无力症状。 方法 选择蚌埠医学院第一附属医院血液净化中心符合入选标准的维持性血液透析患者60例，随机分为3组:血液透析(HD)治疗组、血液透析滤过(HDF)治疗组、血液透析联合血液灌流(HD+HP)治疗组，每组患者20例。比较3组患者治疗6个月前、后血清甲状旁腺激素水平及血清甲状旁腺激素的清除率，观察并记录皮肤瘙痒、骨关节疼痛、肌无力症状改善情况。 结果 3组血清甲状旁腺激素水平较治疗前均有下降，HD组治疗后血清甲状旁腺激素水平下降无统计学意义(P＞0.05)，HDF组、HD+HP组治疗后血清甲状旁腺激素水平均明显降低(P＜0.01)。3组血清甲状旁腺激素清除率比较，HD组为(5.65±3.25)%、HDF组为(40.30±2.70)%、HD+HP组为(41.16±5.30)%，HDF组、HD+HP组均优于HD组(P＜0.01)，HDF组、HD+HP组之间比较差异无统计学意义(P＞0.05)。HDF组、HD+HP组皮肤瘙痒、骨关节疼痛、肌无力症状改善情况均优于HD组(P＜0.05)。 结论 定期进行HDF与HD+HP治疗，可有效清除患者体内血清甲状旁腺激素的蓄积，减少长期透析相关并发症的发生，提高生活质量。 

Effects of different blood purification methods on serum parathyroid hormone of patients on maintenance hemodialysis

Objective To investigate the effects of different blood purification methods on serum parathyroid hormone(PTH) of patient on maintenance hemodialysis,and observe the symptoms improvement of skin itchy,joint pain,muscle weakness in each group. Methods Total 60 cases of patients on maintenance hemodialysis in our blood purification center were enrolled,and randomly divided into three groups:hemodialysis(HD) group,hemodiafiltration(HDF) group,hemoperfusion combined hemodialysis(HD + HP) group,20 cases in each group. After six months,the levels of serum PTH and serum PTH clearance observed,and the skin,itching,joint pain,muscle weakness symptoms improvement were recorded. Results The levels of serum PTH were decreased as compared with that before the treatment; The level of serum PTH in HD group was not significant decrease(P > 0. 05),but in HDF group and HD + HP group were significantly decreased(P < 0. 01). The serum PTH clearance rate in HDF group(40. 30 ±2. 70)% and HDF + HP group(41. 16 ±5. 30)% were better than HD group(5. 65 ±3. 25)%(P < 0. 01),and there were no significant difference between the HDF group and HD + HP group(P > 0. 05); The symptoms improvement of skin itchy,joint pain,muscle weakness in HDF group and HD + HP group were better than HD group(P < 0. 05). Conclusion Treatment with HDF and HD + HP can effectively remove the accumulation of serum PTH,reduce long-term dialysis-related complications and improve quality of life of patients.