CAJ | 학술논문

目的：探讨血液透析(HD)和在线血液透析滤过(online-HDF)两种血液净化模式对合并继发性甲状旁腺功能亢进(SHPT)的维持性血液透析患者血清甲状旁腺激素水平的影响。方法40例合并SHPT维持性血液透析患者按血液净化方法不同随机分为HD组20例和online-HDF组20例，两组患者均观察3个月，比较其治疗前后的血清全段甲状旁腺激素(iPTH)、钙、磷、血尿素、血肌酐、尿素清除分数(spKT/V)和尿素下降率(URR)的变化。结果与治疗前比较，online-HDF组的iPTH水平显著下降[(428±216) pg/ml vs (326±163) pg/ml，P<0.01]，血磷水平显著下降[(2.13±0.28) mmol/L vs (1.51±0.51) mmol/L，P<0.01]，而血钙、血尿素、血肌酐和spKT/V无明显变化(P>0.05)；HD组治疗前与治疗后的各项观察指标比较差异均无统计学意义(P>0.05)；与HD组比较， online-HDF组治疗后血清磷和iPTH均显著下降，差异均有显著统计学意义(P<0.01)。治疗后iPTH水平与血磷水平显著正相关(r=0.78，P<0.01)。结论血液透析滤过能有效清除合并甲旁亢维持性血液透析患者血清磷和甲状旁腺激素。
목적：탐토혈액투석(HD)화재선혈액투석려과(online-HDF)량충혈액정화모식대합병계발성갑상방선공능항진(SHPT)적유지성혈액투석환자혈청갑상방선격소수평적영향。방법40례합병SHPT유지성혈액투석환자안혈액정화방법불동수궤분위HD조20례화online-HDF조20례，량조환자균관찰3개월，비교기치료전후적혈청전단갑상방선격소(iPTH)、개、린、혈뇨소、혈기항、뇨소청제분수(spKT/V)화뇨소하강솔(URR)적변화。결과여치료전비교，online-HDF조적iPTH수평현저하강[(428±216) pg/ml vs (326±163) pg/ml，P<0.01]，혈린수평현저하강[(2.13±0.28) mmol/L vs (1.51±0.51) mmol/L，P<0.01]，이혈개、혈뇨소、혈기항화spKT/V무명현변화(P>0.05)；HD조치료전여치료후적각항관찰지표비교차이균무통계학의의(P>0.05)；여HD조비교， online-HDF조치료후혈청린화iPTH균현저하강，차이균유현저통계학의의(P<0.01)。치료후iPTH수평여혈린수평현저정상관(r=0.78，P<0.01)。결론혈액투석려과능유효청제합병갑방항유지성혈액투석환자혈청린화갑상방선격소。
Objective To compare the effect of different blood purification methods on parathyroid hormone in maintenance hemodialysis patients with secondary hyperparathyroidism (SHPT). Methods Forty patients on main-tenance hemodialysis were randomly divided into two groups:hemodialysis group (HD group, n=20), online hemodia-filtration group (online-HDF group, n=20). Serum phosphorus, serum calcium and serum iPTH levels, blood urea, se-rum creatinine, spKT/V, urea reduction rate (URR) were observed before treatment and three months after treatment. Results Compared with before treatment, the level of serum iPTH in online-HDF group decreased significantly [(428 ± 216) vs (326 ± 163), P<0.01], so did the level of serum phosphorus in online-HDF group [(2.13 ± 0.28) vs (1.51 ± 0.51), P<0.01]. Serum calcium, serum urea, serum creatinine and spKT/V did not change significantly (P>0.05). There were no significant differences in the observed indexes in the HD group before and after treatment (P>0.05). Compared with the HD group, the serum phosphorus and iPTH were significantly decreased after the treatment, and the difference were statistically significant (P<0.01). The level of iPTH after treatment was positively correlated with the level of serum phosphorus (P<0.01, r=0.78). Conclusion Hemodiafiltration can effectively clear iPTH and serum phosphorus in maintenance hemodialysis patients with secondary hyperparathyroidism.