不同血液净化方法对慢性肾功能衰竭维持性血液透析患者血清甲状旁腺素的影响
王成 娄探奇 唐骅 陈珠江 尹培达 余学清【摘要】 目的 比较不同血液净化技术对慢性肾功能衰竭(肾衰)维持性血液透析患者血清甲状旁腺素(PTH)的清除效果。方法符合入选标准的90例慢性肾衰维持性血液透析患者随机分为血液吸附(AP)组、血液透析滤过(HDF)组、血液透析(HD)组3组。AP组接受血液吸附联合血液透析治疗，HDF组接受血液透析滤过1次，HD组接受血液透析治疗。用放射免疫法测定血清PTH水平；记录患者治疗前后血白蛋白、球蛋白、尿素氮、肌酐、PTH的变化，比较3组的肾小球滤过率(GFR)和透析时间。结果①AP组患者治疗后血PTH从(291.7±237.5)ng/L降至(122.2±114.5)ng/L，平均单次清除率为48.6%±55.2%，治疗前后比较有显著性差异(P<0.05)；皮肤瘙痒缓解率为83.3%(10/12例)。②HDF组患者治疗后血PTH从(325.9±423.1)ng/L降至(90.9±93.7)ng/L，平均单次清除率为59.5%±22.7%。治疗前后比较有显著性差异(P<0.05)；皮肤瘙痒缓解率为50.0%(4/8例)。③HD组患者治疗后血PTH从(297.7±211.3)ng/L降至(248.1±105.5)ng/L，平均单次清除率为13.1%±30.2%，治疗前后比较无显著性差异(P>0.05)；皮肤瘙痒缓解率为14.3%(1/7例)。结论 ①血液吸附联合血液透析治疗慢性肾衰能有效清除PTH，缓解皮肤瘙痒症状。②血液透析滤过能有效清除PTH，缓解皮肤瘙痒症状。③血液透析不能有效清除PTH，也不能有效缓解皮肤瘙痒症状。
【关键词】 肾功能衰竭，慢性； 甲状旁腺素； 血液透析； 血液透析滤过； 树脂吸附器
Clearance effect of different blood purification techniques on parathyroid hormone in renal function failure patients on maintenance hemodialysis WANG Cheng, LOU Tan-qi, TANG Hua, CHEN Zhu-jiang, YIN Pei-da, YU Xue-qing.Department of Nephrology, Third Affiliated Hospital, SUN Yat-sen University, Guangzhou 510630, Guangdong, China
【Abstract】OBJECTIVE：To evaluate the effect of different blood purification techniques on serum parathyroid hormone (PTH) level in chronic hemodialysis (HD) patients with renal failure. METHODS：Ninety patients were randomly divided into three groups: absorption (AP) group, hemodiafiltration (HDF) group, and HD group. Patients in AP group received therapy with resin absorptive devices associated with HD, patients in HDF group received HDF, while patients in HD group received HD. Blood routine examination, serum albumin, globulin, blood urea nitrogen, creatinine and PTH were measured before and after these treatments, and vital signs and side effects were recorded during HD. Glomerular filtration rate (GFR) and the length of HD were compared among three group. RESULTS：①Serum PTH in AP group was decrease from(291.7±237.5)ng/L to (122.2±114.5)ng/L ......
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