血液透析滤过串联血液灌流联合骨化三醇冲击治疗对血透患者继发性甲状旁腺功能亢进的临床疗效

doi:10.3877/cma.j.issn.2095-9133.2019.06.004

中华卫生应急电子杂志 ›› 2019, Vol. 05 ›› Issue (06) : 335 -337. doi: 10.3877/cma.j.issn.2095-9133.2019.06.004

所属专题：文献；

论著

血液透析滤过串联血液灌流联合骨化三醇冲击治疗对血透患者继发性甲状旁腺功能亢进的临床疗效

钱小莉¹^,^†(

), 张曼丽¹

^1. 213017　江苏常州，江苏大学附属武进医院肾内科、徐州医科大学武进临床学院

收稿日期:2019-10-22 出版日期:2019-12-18
通信作者: 钱小莉

Effect of hemodialysis combined with hemoperfusion on the treatment of secondary hyperthyroidism with calcitriol

Xiaoli Qian¹^,^†(), Manli Zhang¹

^1. Department of Nephrology, Wujin Hospital Affiliated with Jiangsu University and The Wujin Clinical College of Xuzhou Medical University, Changzhou 213017, China

Received:2019-10-22 Published:2019-12-18
Corresponding author: Xiaoli Qian
About author:
Corresponding author: Qian Xiaoli, Email: xiaoliqian1213@126.com

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目的

探讨血液透析滤过串联血液灌流联合骨化三醇冲击治疗对维持性血液透析患者并发继发性甲状旁腺功能亢进的临床疗效。

方法

选取2019年01月至2019年06月60例维持性血液透析并发继发性甲状旁腺功能亢进的患者作为研究对象，其中男性42例，女性18例；年龄20～68岁，平均(52±17.2)岁。对照组30例，每周常规血液透析3次，联合骨化三醇冲击治疗；研究组30例，每周常规血液透析1次，血液透析滤过1次，血液透析滤过＋血液灌流1次，联合骨化三醇冲击治疗。观察两组患者血钙、血磷、血甲状旁腺素、碱性磷酸酶(ALP)等各项指标变化，并对两组患者的临床症状进行比较分析。

结果

两组患者血甲状旁腺素均降低(P<0.05)；研究组患者的血甲状旁腺素、血磷、碱性磷酸酶明显低于对照组(P<0.05)；对照组治疗后血钙水平上升，较治疗前差异有统计学意义(P<0.05)；研究组治疗前后血钙水平差异无统计学意义(P>0.05)。

结论

对维持性血液透析继发甲状旁腺功能亢进患者应用血液透析滤过串联血液灌流联合骨化三醇冲击治疗不仅能有效降低血甲状旁腺素、血磷、碱性磷酸酶水平，不影响血钙水平，且更能改善患者临床症状，提高生活质量。

关键词: 继发甲状旁腺功能亢进, 血液透析滤过, 骨化三醇

Objective

To investigate the clinical effect of hemodialysis combined with hemoperfusion combined with calcitriol on maintenance hemodialysis patients with secondary hyperparathyroidism.

Methods

Sixty patients with maintenance hemodialysis complicated with secondary hyperparathyroidism from January 2019 to June 2019 were enrolled, including 42 males and 18 females, aged 20-68 years, mean age(52±17.2)years. They were randomly divided into study group and control group, 30 cases in each group. The control group received routine hemodialysis 3 times a week, combined with calcitriol shock treatment; the study group received routine hemodialysis once a week, hemodiafiltration 1 time, blood dialysis filtration plus blood perfusion 1 time, combined with calcitriol shock treatment. The changes of serum calcium, blood phosphorus, blood parathyroid hormone and alkaline phosphatase (ALP) were observed in the two groups, and the clinical symptoms of the two groups were compared and analyzed.

Results

The blood parathyroid hormone was decreased in both groups (P<0.05). The blood parathyroid hormone, serum phosphorus and alkaline phosphatase in the study group were significantly lower than that of the control group, the difference was statistically significant (P<0.05). The blood calcium level of the control group increased before and after treatment, and the difference was statistically significant. There was no significant difference in the serum calcium level between the study group and the control group (P>0.05).

Conclusion

Maintenance of hemodialysis patients with hyperparathyroidism by hemodiafiltration combined with blood perfusion and calcitriol shock treatment can not only effectively reduce blood parathyroid hormone, serum phosphorus and alkaline phosphatase levels, but also improve clinical symptoms and improve quality of life, not affecting the blood calcium levels of patients.

Key words: hyperparathyroidism, Hemodialysis, Calcitriol

表1 两组患者血钙、血磷水平比较(±s)

组别	例数	血钙(mmol/L)		血磷(mmol/L)
组别	例数	治疗前	治疗后	治疗前	治疗后
对照组	30	2.27±0.22	2.42±0.10^a	2.03±0.42	1.97±0.37
研究组	30	2.29±0.13	2.34±0.14^b	2.08±0.36	1.78±0.30^ab
t值	?	0.40	－2.34	0.54	－2.61
P值	?	>0.05	<0.05	>0.05	<0.05

表1 两组患者血钙、血磷水平比较(±s)

组别	例数	血钙(mmol/L)		血磷(mmol/L)
组别	例数	治疗前	治疗后	治疗前	治疗后
对照组	30	2.27±0.22	2.42±0.10^a	2.03±0.42	1.97±0.37
研究组	30	2.29±0.13	2.34±0.14^b	2.08±0.36	1.78±0.30^ab
t值	?	0.40	－2.34	0.54	－2.61
P值	?	>0.05	<0.05	>0.05	<0.05

表2 两组患者iPTH、ALP水平比较(±s)

组别	例数	iPTH(pg/mL)		血ALP(U/L)
组别	例数	治疗前	治疗后	治疗前	治疗后
对照组	30	767.6±418.0	550.0±316.1a	111.6±41.8	110.1±40.0
研究组	30	759.1±394.2	368.9±270.5ab	103.5±37.8	91.5±30.6ab
t值	?	－0.77	－2.06	－0.85	－2.61
P值	?	>0.05	<0.05	>0.05	<0.05

表2 两组患者iPTH、ALP水平比较(±s)

组别	例数	iPTH(pg/mL)		血ALP(U/L)
组别	例数	治疗前	治疗后	治疗前	治疗后
对照组	30	767.6±418.0	550.0±316.1a	111.6±41.8	110.1±40.0
研究组	30	759.1±394.2	368.9±270.5ab	103.5±37.8	91.5±30.6ab
t值	?	－0.77	－2.06	－0.85	－2.61
P值	?	>0.05	<0.05	>0.05	<0.05

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Effect of hemodialysis combined with hemoperfusion on the treatment of secondary hyperthyroidism with calcitriol

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Effect of hemodialysis combined with hemoperfusion on the treatment of secondary hyperthyroidism with calcitriol