三种血液净化方法对维持性血液透析患者矿物质代谢紊乱的影响
삼충혈액정화방법대유지성혈액투석환자광물질대사문란적영향
Effect of three blood purification techniques on minerals disorder in maintenance hemodialysis patients
  • 万方数据
    中国医师进修杂志 중국의사진수잡지
    CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
    2013年 25期 36-39 ,共4页

    缪立英%何小舟%刘金凤%金丽娜

    무립영%하소주%류금봉%금려나

    钙%磷%肾透析%血液透析滤过%血液灌流 鈣%燐%腎透析%血液透析濾過%血液灌流
    개%린%신투석%혈액투석려과%혈액관류
    Calcium%Phosphorus%Renal dialysis%Hemodiafiltration%Hemoperfusion
    目的 探讨三种血液净化方法对维持性血液透析患者矿物质代谢紊乱的影响,为患者选择血液净化方法提供临床指导依据.方法 88例维持性血液透析患者按血液净化方法不同分为血液透析(HD)组(30例)、血液透析滤过(HDF)组(30例)和血液灌流(HP)组(28例).检测并比较三组治疗前后血清尿素氮、肌酐、钙、磷、全段甲状旁腺激素(iPTH)和成纤维细胞生长因子(FGF)-23等.结果 HD组、HDF组和HP组血清磷治疗前分别为(1.93±0.44)、(2.11±0.54)、(2.17±0.59)mmol/L,治疗后分别为(1.01±0.23)、(0.84±0.19)、(0.99±0.27)mmol/L,三组治疗前后比较差异有统计学意义(P＜0.05).三组血清磷下降率比较差异无统计学意义(P＞0.05).三组血清磷清除指数比较差异无统计学意义(P＞0.05).HD组血清iPTH从治疗前的(48.8±42.9) pmol/L,升至治疗后的(49.9±42.9) pmol/L.HDF组和HP组血清iPTH从治疗前的(64.7±45.4)、(50.4±45.9) pmol/L,降至治疗后的(46.2±37.8)、(35.8±36.5) pmol/L,治疗前后比较差异有统计学意义(P＜0.05).HDF组和HP组血清iPTH下降率、清除指数比较差异无统计学意义(P＞0.05).HD组血清FGF-23治疗前后比较差异无统计学意义(P＞0.05).HDF组和HP组血清FGF-23分别从治疗前的(782.5±105.8)、(879.5±97.2) ng/L,降至治疗后的(712.0±98.1)、(823.5±89.1) ng/L,治疗前后比较差异有统计学意义(P＜0.05).HD组、HDF组、HP组血清FGF-23下降率分别为(5.7±2.8)％、(12.3±6.2)％和(9.1±4.6)％,三组间比较差异有统计学意义(P＜0.05).HD组、HDF组、HP组血清FGF-23清除指数分另为0.06±0.05、0.19±0.11和0.12±0.08,三组间比较差异有统计学意义(P＜0.05).三组尿素下降率和清除指数比较差异无统计学意义(P＞0.05).结论 HD仅对血清磷有清除效果,HDF和HP对血清磷、iPTH及FGF-23都有清除效果,且HDF对血清FGF-23清除效果更佳.选择HDF和HP血液净化方法,对于降低维持性血液透析患者矿物质代谢紊乱,改善患者的长期预后具有重要的临床意义.
    목적 탐토삼충혈액정화방법대유지성혈액투석환자광물질대사문란적영향,위환자선택혈액정화방법제공림상지도의거.방법 88례유지성혈액투석환자안혈액정화방법불동분위혈액투석(HD)조(30례)、혈액투석려과(HDF)조(30례)화혈액관류(HP)조(28례).검측병비교삼조치료전후혈청뇨소담、기항、개、린、전단갑상방선격소(iPTH)화성섬유세포생장인자(FGF)-23등.결과 HD조、HDF조화HP조혈청린치료전분별위(1.93±0.44)、(2.11±0.54)、(2.17±0.59)mmol/L,치료후분별위(1.01±0.23)、(0.84±0.19)、(0.99±0.27)mmol/L,삼조치료전후비교차이유통계학의의(P＜0.05).삼조혈청린하강솔비교차이무통계학의의(P＞0.05).삼조혈청린청제지수비교차이무통계학의의(P＞0.05).HD조혈청iPTH종치료전적(48.8±42.9) pmol/L,승지치료후적(49.9±42.9) pmol/L.HDF조화HP조혈청iPTH종치료전적(64.7±45.4)、(50.4±45.9) pmol/L,강지치료후적(46.2±37.8)、(35.8±36.5) pmol/L,치료전후비교차이유통계학의의(P＜0.05).HDF조화HP조혈청iPTH하강솔、청제지수비교차이무통계학의의(P＞0.05).HD조혈청FGF-23치료전후비교차이무통계학의의(P＞0.05).HDF조화HP조혈청FGF-23분별종치료전적(782.5±105.8)、(879.5±97.2) ng/L,강지치료후적(712.0±98.1)、(823.5±89.1) ng/L,치료전후비교차이유통계학의의(P＜0.05).HD조、HDF조、HP조혈청FGF-23하강솔분별위(5.7±2.8)％、(12.3±6.2)％화(9.1±4.6)％,삼조간비교차이유통계학의의(P＜0.05).HD조、HDF조、HP조혈청FGF-23청제지수분령위0.06±0.05、0.19±0.11화0.12±0.08,삼조간비교차이유통계학의의(P＜0.05).삼조뇨소하강솔화청제지수비교차이무통계학의의(P＞0.05).결론 HD부대혈청린유청제효과,HDF화HP대혈청린、iPTH급FGF-23도유청제효과,차HDF대혈청FGF-23청제효과경가.선택HDF화HP혈액정화방법,대우강저유지성혈액투석환자광물질대사문란,개선환자적장기예후구유중요적림상의의.
    Objective To investigate the effect of three blood purification techniques on minerals disorder in maintenance hemodialysis patients,and provide clinical guidance for patients to choice the blood purification techniques.Methods Eighty-eight maintenance hemodialysis patients were divided into three groups according to the blood purification techniques:hemodialysis (HD) group (30 cases),hemodiafiltration (HDF) group (30 cases),and hemoperfusion (HP) group (28 cases).Serum urea nitrogen,creatinine,calcium,phosphorus,intact parathyroid hormone (iPTH),ftbroblast growth factor (FGF)-23 and so on before and after treatment were measured and compared among the groups.Results The serum phosphorus in HD group,HDF group and HP group before treatment were (1.93 ±0.44),(2.11 ±0.54) and (2.17 ±0.59)mmol/L,and after treatment were (1.01 ±0.23),(0.84 ±0.19),(0.99 ±0.27) mmol/L.There were significant differences in serum phosphorus level after treatment compared with that before treatment in the three groups (P ＜0.05).There were no significant differences in the descend rate of serum phosphorus among the three groups (P ＞0.05).There were no significant differences in clearance index of serum phosphorus among the three groups (P ＞ 0.05).The serum iPTH in HD group before treatment was (48.8 ± 42.9) pmol/L,and after treatment was (49.9 ± 42.9) pmol/L.The serum iPTH in HDF group and HP group before treatment were (64.7 ± 45.4) and (50.4 ± 45.9) pmol/L,after treatment was (46.2 ± 37.8) and (35.8 ± 36.5) pmol/L.There were significant differences in serum iPTH level after treatment compared with that before treatment (P ＜ 0.05).There were no significant differences in the descend rate and clearance index of serum iPTH in HDF group and HP group (P ＞ 0.05).There was no significant difference in serum FGF-23 in HD group before and after treatment (P＞ 0.05).The serum FGF-23 in HDF group and HP group before treatment were (782.5 ± 105.8) and (879.5 ±97.2) ng/L,after treatment were (712.0 ±98.1),(823.5 ± 89.1) ng/L.There were significant differences in serum iPTH level after treatment compared with that before treatment in HDF group and HP group (P ＜ 0.05).The descend rate of serum FGF-23 in HD group,HDF group and HP group were (5.7 ±2.8)％,(12.3 ±6.2)％ and (9.1 ±4.6)％,and there was significant difference among the three groups (P ＜0.05).The clearance index of serum FGF-23 in HD group,HD F group and HP group were 0.06 ± 0.05,0.19 ± 0.11 and 0.12 ± 0.08,and there were significant differences among the three groups (P ＜ 0.05).There were no significant differences in the descend rate and clearance index of serum urea among the three groups (P ＞ 0.05).Conclusions HD can only clear serum phosphorus.HDF and HP can clear serum phosphorus,iPTH and FGF-23 effectively,while HDF has better clearance effect on FGF-23.The HDF and HP blood purification can reduce minerals disorder in maintenance hemodialysis patients and has important clinical significance in improving the long-term prognosis of the patients.
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