王文静,方靖
WANG Wenjing,FANG Jing

• 1:黄山首康医院血液透析室
• 2:黄山首康医院肾内科

摘要(Abstract)：

目的:探讨高通量血液透析(HFHD)对尿毒症患者血清钙磷代谢的影响。方法:66例尿毒症患者均分为对照组和观察组,在常规治疗的基础上,观察组采用HFHD治疗,对照组采用血液透析(HD)治疗,均为3次/周,连续治疗6个月;分别于透析前和透析6个月时,检测2组患者血清甲状旁腺素(i PTH)、钙、磷、血清肿瘤坏死因子-α(TNF-α)及超敏C反应蛋白(hs-CRP)水平,检测患者左室舒张/收缩末期内径(LVEDD/LVESD),计算左室射血分数(LVEF),计算患者透析6个月时血清i PTH、钙及磷的达标率;观察2组透析期间营养不良及各种心血管事件发生率,采用简明健康检查量表(SF-36)评评估患者生活质量。结果:透析前,2组尿毒症患者血清i PTH、钙、磷、TNF-α、hs-CRP水平及LVEDD、LVEDS、LVEF比较,差异无统计学意义(P>0.05);透析6个月时,2组患者血清i PTH、磷、TNF-α及hs-CRP水平较透析前显著降低,观察组降低更明显(P<0.05),血清钙水平无明显变化(P>0.05);透析6个月时,观察组患者血清i PTH、钙及磷的达标率显著高于对照组(P<0.05);与透析前比较,2组LVEDD、LVEDS、LVEF水平仅观察组LVEF升高(P<0.05),其余指标无明显变化(P>0.05);透析期间,观察组营养不良发生率及总不良反应发生率显著低于对照组(P<0.05);透析6个月时,观察组SF-36评分高于对照组(P<0.05)。结论:HFHD可有效降低尿毒症患者血清i PTH、磷及炎性因子水平,改善患者心功能,提高患者生活质量。
Objective: To investigate the effects of high-throughput hemodialysis( HFHD) on calcium and phosphorus metabolism in patients with uremia. Methods: A total of 66 patients with uremia admitted to our hospital from October 2014 to June 2017 were enrolled and divided into the control group( n = 33) and the observation group( n = 33). On the basis of conventional therapy,the observation group was treated with HFHD,while the control group was treated with hemodialysis( HD).Both of the treatment were 3 times per week and the two groups were treated for 6 months. Serum i PTH,levels of calcium,phosphorus,factor-α,hs-CRP,LVEDD and LVESD of patients in the two groups were determined respectively before and after the six-month dialysis. The LVEF and the standard rates of serum i PTH,calcium and phsosphorus were calculated. The incidence of malnutrition and various cardiovascular events during the dialysis were observed and the quality of life was evaluated by SF-36. Results: There was no significant difference in levels of serum i PTH,calcium,phosphorous,TNF-α,hs-CRP and comparisons of LVEDDD,LVEDS and LVEF of patients with uremia in the two groups before dialysis( P > 0. 05). After the six-month dialysis,the levels of serum i PTH,TNF-α and hs-CRP of patients in the two groups were significantly lower than those before the dialysis,especially in the observation group( P < 0. 05),while there was no significant change in serum calcium level( P> 0. 05). Afte the six-month dialysis,the serum IPTHs,calcium and phosphorus levels in the observation group were significantly higher than those in the control group( P < 0. 05). Concerning the levels of LVEDD,LVEDS and LVEF,only LVEF in the observation group increased( P < 0. 05),and no significant change was found in other indexes( P > 0. 05). During the dialysis,the incidence of malnutrition and total adverse reactions in the observation group was significantly lower than that in the control group( P < 0. 05),and after the six-month dialysis,the SF-36 score in the observation group was higher than that in the control group( P < 0. 05). Conclusions: HFHD can effectively reduce the levels of serum i PTH,phosphorus and inflammatory factors in uremic patients,and improve the heart function and the quality of life of patients.

关键词(KeyWords)： 血液透析;尿毒症;高通量筛选;钙磷代谢;心功能;微炎症状态;生活质量
hemodialysis;uremia;high flux;calcium and phosphorus metabolism;cardiac function;inflammatory state;quality of life

Abstract:

Keywords:

基金项目(Foundation): 保定市科学技术和知识产权局(17ZF112)

作者(Author): 王文静,方靖
WANG Wenjing,FANG Jing

DOI: 10.19367/j.cnki.1000-2707.2018.06.018

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