血液净化方式对维持性血液透析患者血磷及甲状旁腺激素的影响

目的:观察3种不同血液净化方式对维持性血液透析(MHD)患者血磷及血甲状旁腺激素水平的影响。方法:选取2013年1月至2013年6月于晋城市人民医院血液净化中心行MHD患者60例为研究对象,患者均在透析液钙离子浓度1.5 mmol/L的基础上,血磷值大于1.78 mmol/L、血全段甲状旁腺激素(i PTH)值大于300 pg/ml,随机分为3组:血液透析组(HD组)、血液透析+血液灌流组(HD+HP组)、血液透析+血液透析滤过组(HD+HDF组),每组20例,均治疗6个月,检测治疗前后血钙、血磷、血i PTH水平的变化。结果:1 3组患者治疗后血磷水平较治疗前均显著下降(P<0.05),HD+HDF组与HD+HP组对血磷的清除率比较,差异无统计学意义(P>0.05),此两组的清除率与HD组比较,差异均有统计学意义(P<0.05);2 HD组治疗前后血i PTH水平无显著下降(P>0.05),HD+HP组与HD+HDF组治疗后血i PTH水平较治疗前均显著下降(P<0.05),且HD+HP组清除率与HD+HDF组比较差异有统计学意义(P<0.05);3 3组患者治疗后血钙水平较治疗前均有所升高,但组间差异无统计学意义(P>0.05)。结论:3种不同血液净化方式均可有效清除血磷,且HD+HDF及HD+HP清除血磷的效果明显优于HD;HD不能清除血PTH,HD+HDF及HD+HP均能有效清除血PTH,尤以HP+HD清除效果更好。

The influence of different blood purification methods on blood phosphorus and parathyroid hormone in patients with mainte-nance hemodialysis

Objective： To observe the influence of three different kinds of blood purification methods for blood phosphorus and parathyroid hormone levels in patients with maintenance hemodialysis（ MHD）. Methods： 60 patients with maintenance hemodialysis（ MHD） were selected as the research objects in the blood purification center of Jincheng people＇s hospital from January to June of2013. The blood phosphorus level of all patients was higher than 1. 78 mmol / L and parathyroid hormone（ i PTH） level was higher than 300 pg / ml,based on the blood calcium concentration tendency for 1. 5 mmol / L in dialysate. They were randomly divided into three groups,including hemodialysis group（ HD group）,hemodialysis and blood perfusion group（ HD ＋ HP group）,hemodialysis and hemodialysis filtration group（ HD ＋ HDF group）,and all patients were cured for 6months. And then the levels of serum calcium,phosphate and intact parathyroid hormone（ i PTH）were detected. Results： ① The blood phosphorus of all the three groups patients after treatment were significantly decreased（ P〈0. 05）,and there was no statistically significant difference between HD ＋ HDF and HD ＋ HP group（ P〉0. 05）. Compared with HD group,both of the other two groups had statistical significance（ P〈0. 05）; ②The levels of serum i PTH before and after treatment didn＇t significantly changed in the HD group（ P〉0. 05）,however the levels of serum i PTH were significantly decreased in other two groups after treatment（ P〈0. 05）. There was a significant difference between HD ＋ HDF group and HD ＋ HP group（ P〈0. 05）; ③ The levels of blood calcium in all the three groups after treatment were increased,but there was no statistically significant difference between groups（ P〉0. 05）. Conclusion： All the three different kinds of blood purification methods could effectively remove blood phosphorus. The effect of HD ＋ HDF and HD ＋ HP was better than pure HD; HD ＋ HDF and HD ＋ HP could effective