联机血液透析滤过纠正尿毒症血液透析患者钙磷代谢紊乱临床观察

目的 探讨联机血液透析滤过(HDF)、综合血液透析(HD)对患者钙、磷、甲状旁腺激素(PTH)清除效果.方法 取本血液净化中心维持性血液透析患者40例,随机分为两组,联机HDF组(n=20)和HD组(n=20).维持透析6个月后检测透析前、透析后钙、磷、PTH.结果 联机HDF组透析前后血钙水平为(1.90±0.35) mmol/L vs(2.20±0.67)mmol/L,HD组分别为(2.02±0.22)mmol/L vs (2.30±0.18) mmol/L,两组透析后血钙均有轻度升高,但两组透析后差异无统计学意义(P＞0.05)；联机HDF组透析前后血磷水平为(2.45±0.41) mmol/L vs (1.70±0.15)mmol/L；而HD组分别为(2.52±0.60) mmol/L vs(1.82±0.20)mmol/L,两组患者接受透析后较透析前其血磷浓度均有明显的降低,并且两组透析后差异有统计学意义(P＜0.05).联机HDF组透析前后血PTH为(702.0±14.3)ng/L vs(345.0±16.8)ng/L; HD组分别为(697.2±13.2)ng/L vs(391.7±19.4)ng/L,两组患者在接受治疗后均有明显的降低,而联机组患者其治疗后含量明显低于HD组(P＜0.05).结论 联机HDF可以有效清除维持性血液透析患者血液中钙、磷PTH,改善患者预后.

On-line hemodiafiltration to correct calcium and phosphate metabolic disorder in uremia hemodialysis patients

Objective To explore the effect of on-line hemodiafiltration（HDF）, comprehensive hemodialysis （HD） and hemofiltration（HF） in removal of calcium, phosphorus, parathyroid hormone（PTH） for maintenance HD patients. Methods Forty maintenance hemodialysis patients from the blood purification center were selected and they were randomly divided into two groups,online HDF group（ n = 20） and HD group（ n = 20）. After 6 months of maintenance hemodialysis,the patients pre dialysis and post-dialysis were detected in calcium, phosphorus and PTH. Results In on-line HDF group,serum calcium concentration pre-dialysis and post-dialysis was （1. 904±0.35） mmol/L vs （2. 20±0.67） mmol/L,HD group was respectively （2.02±0.22） mmol/L vs （2. 30±0.18） mmol/L,both groups showed slight increase in calcium but in post-dialysis comparison, the two groups showed no significant difference（ P〉 0.05）. In online HDF group, serum phosphate concentration pre-dialysis and post-dialysis was （2.45±0.41） mmol/L vs （1.70±0.15） mmol/L,while in HD group,it was （2. 52±0.60） mmol/L vs （1.82±0.20） mmol/L,and both groups in post-dialysis treatment compared with pre-dialysis showed significant decrease in serum phosphate levels,and the two groups showed significant difference in post-dialysis （P 〈0.05）. In on-line HDF group, serum PTH pre- dialysis and post-dialysis was （702.0±14.3） ng/L vs （345.0± 16.8） ng/L, HD group was （697.2± 13.2） ng/L vs （391.7±19.4） ng/L, two groups after receiving the treatment showed significantly lower PTH,on-line HDF group was significantly lower than HD group （ P 〈0.05）. Conclusion On-line HDF can effectively remove blood calcium, phosphorus,and PTH of maintenance HD patients.