摘要
目的探讨高通量血液透析对尿毒症合并继发性甲状旁腺功能亢进(SHPT)患者的甲状旁腺激素和钙磷代谢的影响。方法选取2012年1月值2014年12月在大连医科大学附属第二医院行血液透析的尿毒症合并SHPT患者70例为研究对象,将患者随机分为A组和B组,各35例。A组和B组患者分别给予高通量和低通量血液透析。比较两组患者透析前及透析后第6、12个月的甲状旁腺激素(iPTH)、血钙、血磷、碱性磷酸酶(AKP)、骨型碱性磷酸酶水平(骨型AKP)、透析充分性指标;计算并比较其生存率,进行相关性分析与Logistic回归分析。结果 A组和B组的iPTH、骨型AKP、血磷与透析时间存在交互作用;两组血磷、iPTH、骨型AKP水平比较,差异有统计学意义(P<0.05)。两组透析后6、12个月血磷、iPTH、骨型AKP水平比较,差异均有统计学意义(P<0.05)。血磷、iPTH、骨型AKP水平不同时间间差异有统计学意义(P<0.05)。A组患者生存率为88.5%(31/35),B组生存率为71.4%(25/35),A组生存率明显高于B组,差异有统计学意义(χ2=6.52,P=0.03)。结论高通量血液透析能够降低尿毒症合并SHPT患者的iP TH水平并改善其磷代谢紊乱;且高通量血液透析可以改善尿毒症合并SHPT患者的生存率。
Objective To investigate the clinical effect of high flux hemodialysis in the treatment of patients with uremia associated with secondary hyperparathyroidism（ SHPT）. Methods A total of 40 patients who were on dialysis in Dalian Medical University from January 2012 to December 2014 and met inclusion and exclusion criteria were selected and randomly divided into group A（ n = 35） and group B（ n = 35）.Group A was treated with high flux dialysis,and group B was treated with low flux dialysis. The blood calcium,blood phosphorus,intact parathyroid hormone（ iPTH）,alkline phosphatase（ AKP）,bone- type alkaline phosphatase,parameters for dialysis adequacy and survival rate of the two groups were compared before dialysis,6 months,12 months after dialysis. Correlation analysis and Logistic regression analysis were also performed. Results The dialysis time had interactive effect on blood phosphorus,iPTH and bone- type alkaline phosphatase（ P〈0. 05）. The two groups showed significant differences in blood phosphorus,iPTH and bone- type alkaline phosphatase（ P〈0. 05）. The two groups also showed significant differences in blood phosphorus,iPTH and bone- type alkaline phosphatase,6 months,and 12 months after dialysis（ P〈0. 05）.The blood phosphorus,iPTH and bone- type alkaline phosphatase at different time showed significant differences（ P〈0. 05）. The dialysis time had no interactive effect on KT / V and URR（ P〉0. 05）. The survival rate in group A and group B was 88. 5%（ 31 /35） and 71. 4%（ 25 /35）,respectively,and the difference was significant（ χ2= 6. 52,P = 0. 03）. Conclusion High flux hemodialysis can reduce iPTH level and improve metabolic disorders of calcium and phosphorus for patients with uremia associated with SHPT.
出处
《临床和实验医学杂志》
2015年第20期1716-1719,共4页
Journal of Clinical and Experimental Medicine
关键词
尿毒症
甲状旁腺功能亢进症
高通量血液透析
甲状旁腺素
钙磷代谢
Uremia
Secondary Hyperparathyroidism
High throughput hematodialysis
Parathyroid hormone
Calcium-phosphorus Metabolism
