CAJ | 학술논문

目的探讨6种不同血液净化方法对尿毒症患者血磷及甲状旁腺激素(parathyroid hormone,PTH)的清除效果.方法选取在我院维持性血液透析血磷的患者200例并采用数字表法随机分为6组:血液透析联合血液灌流(HD+ HP130)组、HD+ HP230组、血液透析滤过(HDF)组、血液透析(HD)组、床旁血液滤过(CVVH)组和高通量血液透析(HFHD)组.比较6组血液净化单次治疗前后血磷及血PTH清除率.结果 HD组治疗后血PTH值下降,但差异无统计学意义(P＞0.05);血磷治疗后下降且差异有统计学意义(P＜0.05).HDF组和HFHD组治疗后血PTH值及血磷值均下降,差异有统计学意义(P＜0.05).CVVH组治疗后血PTH下降明显,差异有统计学意义(P＜0.01),HD+ HP130和HD+ HP230组治疗后血PTH下降,差异有统计学意义(P＜0.05),且均显著高于HDF组(P＜0.05)和HFHD组,血磷值下降且差异有统计学意义(P＜0.05).结论血液透析联合血液灌流、床旁血液滤过、高通量血液透析及血液透析滤过均能有效清除血磷及PTH,清除效果依次为CVVH组＞HD+ HP230组＞HD+ HP130组＞HDF组＞HFHD组.血液透析可以有效清除血磷但不能有效清除PTH.
목적 탐토6충불동혈액정화방법대뇨독증환자혈린급갑상방선격소(parathyroid hormone,PTH)적청제효과.방법 선취재아원유지성혈액투석혈린적환자200례병채용수자표법수궤분위6조:혈액투석연합혈액관류(HD+ HP130)조、HD+ HP230조、혈액투석려과(HDF)조、혈액투석(HD)조、상방혈액려과(CVVH)조화고통량혈액투석(HFHD)조.비교6조혈액정화단차치료전후혈린급혈PTH청제솔.결과 HD조치료후혈PTH치하강,단차이무통계학의의(P＞0.05);혈린치료후하강차차이유통계학의의(P＜0.05).HDF조화HFHD조치료후혈PTH치급혈린치균하강,차이유통계학의의(P＜0.05).CVVH조치료후혈PTH하강명현,차이유통계학의의(P＜0.01),HD+ HP130화HD+ HP230조치료후혈PTH하강,차이유통계학의의(P＜0.05),차균현저고우HDF조(P＜0.05)화HFHD조,혈린치하강차차이유통계학의의(P＜0.05).결론 혈액투석연합혈액관류、상방혈액려과、고통량혈액투석급혈액투석려과균능유효청제혈린급PTH,청제효과의차위CVVH조＞HD+ HP230조＞HD+ HP130조＞HDF조＞HFHD조.혈액투석가이유효청제혈린단불능유효청제PTH.
Objective To investigate the removal effect of six different blood purification ways on phosphorus and PTH of uremic patients.Methods A total of 200 patients whose hemodialysis phosphorus were greater than 1.70 mmol/L and PTH were greater than 300 pg/ml were selected and were divided randomly into 6 groups:hemodialysis combined with hemoperfusion (HD + HP130) group,HD + HP230 group,hemodiafiltration (HDF) group,hemodialysis (HD) group,continuous veno-venous hemofiltration (CVVH) group and high-flux hemodialysis (HFHD) group.Compare clearance rate of phosphorus and PTH blood with these six groups before and after treatment.Results PTH of HD group decreased after the treatment,but there was no statistically significant difference (P ＞ 0.05) ; while after phosphorus treatment,PTH decreased and there was statistically significant difference (P ＜ 0.05).Both PTH and phosphorus in HDF group and HFHD group decreased after the treatment and there was statistically significant difference (P ＜ 0.05).PTH of CVVH group decreased obviously after the treatment and there was statistically significant difference (P ＜ 0.01),PTH decreased in HD + HP130 and HD + HP230 group after the treatment; There was statistically significant difference (P ＜ 0.05),which was higher than HDF group (P ＜ 0.05) and HFHD group.Moreover,phosphorus decreased and there was statistically significant difference (P ＜ 0.05).Conclusions Hemodialysis combined with hemoperfusion,continuous veno-venous hemofiltration,high-flux hemodialysis and hemodiafiltration can effectively remove phosphorus and PTH.The removal result was CVVH group ＞ HD+ HA230 group ＞ HD+ HA130 group ＞ HDF group ＞ HFHD group.What's more,hemodialysis can effectively remove phosphorus but cannot effectively remove PTH.