摘要
目的探讨碳酸镧联合不同血液净化方式对慢性肾脏病-矿物质和骨代谢异常(chronic kidney disease mineral and bone disorder,CKD-MBD)患者钙磷代谢的影响,为CKD-MBD患者选择最佳治疗方案,改善患者的生存质量。方法选择陕西省人民医院2014年1月至2015年5月行维持性血液透析的CKD-MBD患者76例,给予口服碳酸镧并按透析方式分为3组,血液透析(hemodialysis,HD)组24例、血液透析联合血液透析滤过(HD and hemodialysis filtration,HD+HDF)组27例,血液透析联合血液灌流(HD and blood perfusion,HD+HP)组25例,比较各组治疗前和治疗3个月后血钙、血磷、钙磷乘积及甲状旁腺素(parathyroid hormone,PTH)的变化。观察3组治疗中不良反应的发生率并进行比较。结果治疗3个月后,3组血钙较治疗前均升高,3组间血钙变化无统计学差异(P>0.05);3组血磷及钙磷乘积较治疗前明显下降(P<0.05),但HD+HDF组、HD+HP组较HD组下降更为明显(P<0.05)。HD组门H在治疗前、后变化不大(P>0.05),HD+HDF组和HD+HP组治疗3个月后PTH较前明显下降(P<0.05)。HD组、HD+HDF组及HD+HP组患者并发症发生率分别为75.0%、18.5%、32.0%,HD组并发症明显高于HD+HDF组和HD+HP组,差异有统计学意义(P<0.05),HD+HDF组并发症发生率最低。结论碳酸镧联合不同血液净化方式对血钙、血磷及PTH的清除效果不同,联合HDF和HP方式能明显清除血磷、PTH,改善钙磷代谢紊乱,不良反应小,适合临床应用治疗CKD-MBD。
Objective To observe the influence of lanthanum carbonate combined with three different kinds of blood purification methods on chronic kidney disease mineral and bone disorder（CKD- MBD） in patients receiving maintenance hemodialysis（MHD） so as to provide the optimal treatment for and improve the quality of life of patients with CKD-MBD. Methods Seventy-six CKD-MBD patients given MHD were selected as the research objects in the Blood Purification Center of Shanxi Provincial People＇s Hospital from January of 2014 to May of 2015. All patients were treated with lanthanum carbonate. They were randomly divided into three groups, including hemodialysis group （HD group, n = 24）, hemodialysis and hemodialysis filtration group（HD ＋ HDF group, n = 27）, hemodialysis and blood perfusion group（HD ＋ HP group, n = 25）, and all patients were cured for three months. Then the levels of serum calcium, phosphate, parathyroid hormone（PTH） and the calciumphosphorus product were detected. The incidence of adverse reactions in the three groups were observed and compared. Results The levels of blood calcium in the three groups were increased after three months, but there was no statistically difference among three groups （P〉0. 05）. The blood phosphorus and calcium-phosphorus product in all patients after treatment was significantly decreased （P〈0. 05）, hut there was no statistically difference between HD ＋ HDF and HD ＋ HP groups （P〉 0. 05）. There was significant difference between HD＋ HDF or HD＋ HP and HD group （P〈0. 05）.The levels of serum PTH had no significant change in the HD group before and after treatment （P〉 0. 05）, however the levels of serum PTH were significantly decreased in HD ＋ HDF group and HD ＋ HP group after treatment （P〈0. 05）. There was no significant difference between HD ＋ HDF group and HD＋ HP group （P〉0. 05）. The incidence of complications was 75%, 18. 51% and 32% in HD group, HD ＋ HDF group and HD ＋ HP group respectively. The
作者
张蓬杰
杜鹏
罗红梅
丁通
董妮
ZHANG Peng-jie DUPeng LUO Hong-mei DING Tong DONG Ni.(The Center of Kidney Diseases and Hemodialysis, Shanxi Provincial People＇s Hospital, Xi＇an 710068, China)
出处
《临床肾脏病杂志》
2016年第9期543-547,共5页
Journal Of Clinical Nephrology
