CAJ | 학술논문

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( iPTH)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iPTH水平的变化。结果：①3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iPTH水平无显著下降(P>0.05),HD+HP组与HD+HDF组治疗后血iPTH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)；③3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。
목적：：관찰3충불동혈액정화방식대유지성혈액투석( MHD)환자혈린급혈갑상방선격소수평적영향。방법：선취2013년1월지2013년6월우진성시인민의원혈액정화중심행MHD환자60례위연구대상,환자균재투석액개리자농도1.5 mmol/L적기출상,혈린치대우1.78 mmol/L、혈전단갑상방선격소( iPTH)치대우300 pg/ml,수궤분위3조：혈액투석조( HD조)、혈액투석+혈액관류조( HD+HP조)、혈액투석+혈액투석려과조( HD+HDF조),매조20례,균치료6개월,검측치료전후혈개、혈린、혈iPTH수평적변화。결과：①3조환자치료후혈린수평교치료전균현저하강(P<0.05),HD+HDF조여HD+HP조대혈린적청제솔비교,차이무통계학의의(P>0.05),차량조적청제솔여HD조비교,차이균유통계학의의(P<0.05)；② HD조치료전후혈iPTH수평무현저하강(P>0.05),HD+HP조여HD+HDF조치료후혈iPTH수평교치료전균현저하강(P<0.05),차 HD+HP조청제솔여 HD+HDF 조비교차이유통계학의의(P <0.05)；③3조환자치료후혈개수평교치료전균유소승고,단조간차이무통계학의의(P>0.05)。결론：3충불동혈액정화방식균가유효청제혈린,차HD+HDF급HD+HP청제혈린적효과명현우우HD；HD불능청제혈PTH,HD+HDF급HD+HP균능유효청제혈PTH,우이HP+HD청제효과경호。
Objective:To observe the influence of three different kinds of blood purification meth-ods for blood phosphorus and parathyroid hormone levels in patients with maintenance hemodialysis ( MHD) . Methods:60 patients with maintenance hemodialysis ( MHD) were selected as the re-search objects in the blood purification center of Jincheng people's hospital from January to June of 2013 . The blood phosphorus level of all patients was higher than 1 . 78 mmol/L and parathyroid hormone ( iPTH) level was higher than 300 pg/ml, based on the blood calcium concentration tend-ency for 1. 5 mmol/L in dialysate. They were randomly divided into three groups, including hemo-dialysis group ( HD group) , hemodialysis and blood perfusion group ( HD+HP group) , hemodial-ysis and hemodialysis filtration group ( HD +HDF group ) , and all patients were cured for 6 months. And then the levels of serum calcium, phosphate and intact parathyroid hormone ( iPTH)were detected. Results: ①The blood phosphorus of all the three groups patients after treatment were significantly decreased ( P<0 . 05 ) , and there was no statistically significant difference be-tween 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 iPTH before and after treatment didn’t significantly changed in the HD group (P>0. 05), however the levels of serum iPTH were significantly decreased in other two groups after treatment ( P<0 . 05 ) . There was a sig-nificant difference between HD+HDF group and HD +HP group ( P <0 . 05 ); ③The 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 effectively remove serum iPTH, especially for HP + HD, but not pure HD.