高通量血液透析在尿毒症合并继发性甲状旁腺功能亢进中的应用研究

摘要

目的：探讨高通量血液透析对尿毒症合并继发性甲状旁腺功能亢进（ SHPT）患者的疗效。方法选取2012年7月—2013年3月在宁波市第七医院行血液透析的尿毒症合并 SHPT 患者40例为研究对象，通过掷硬币的方法将患者随机分为 A 组和 B 组，各20例。A 组给予高通量血液透析，B 组给予低通量血液透析。比较两组患者透析前及透析后第3、6、9、12个月的血钙、血磷、甲状旁腺激素（iPTH）、碱性磷酸酶（AKP）、骨型碱性磷酸酶水平、透析充分性指标〔尿素氮清除分数（ KT/ V）、尿素氮下降率（ URR）〕，计算并比较其生存率，进行相关性分析与Logistic 回归分析。结果两组血磷、iPTH、骨型碱性磷酸酶水平与透析时间存在交互作用（ P ＜0.05）。两组血磷、iPTH、骨型碱性磷酸酶水平比较，差异有统计学意义（P ＜0.05）。两组透析后第3、6、9、12个月血磷、iPTH、骨型碱性磷酸酶水平比较，差异均有统计学意义（P ＜0.05）。血磷、iPTH、骨型碱性磷酸酶水平不同时间间差异有统计学意义（P ＜0.05）。两组 KT/ V、URR 与透析时间不存在交互作用（P ＞0.05）。A 组生存率为90.0%（18/20），B 组生存率为75.0%（15/20），两组生存率比较，差异无统计学意义（χ2＝0.69，P ＝0.41）。相关性分析结果显示：血钙与iPTH 呈正相关（r ＝0.926，P ＝0.03），血磷、骨型碱性磷酸酶与 iPTH 均呈负相关（ r ＝-1.802、-0.833，P ＜0.05）。Logistic 回归分析结果显示：血钙、血磷、骨型碱性磷酸酶是 iPTH 的影响因素（P ＜0.05）。结论高通量血液透析能够降低尿毒症合并 SHPT 患者的 iPTH 水平并改善其磷代谢紊乱。%Objective To investigate the clinical effect of high flux hemodialysis in the treatment of patients with uremia associated with secondary hyperparathyroidism(SHPT). Methods A total of 40 patients who were on dialysis in Ningbo No. 7 Hospital from July 2012 to March,2013 and met inclusion and exclusion criteria were selected and randomly divided into group A(n = 20)and group B(n = 20). Group A was treated with high flux dialysis,and group B was treated with low flux dialysis. The blood calcium,blood phosphorus,intact parathyroid hormone(iPTH),alkline phosphatase(AKP),bone - type alkaline phosphatase,parameters for dialysis adequacy( KT/ V,URR),and survival rate of the two groups were compared before dialysis,3 months,6 months,9 months and 12 months after dialysis. Correlation analysis and Logistic regression analysis were also performed. Results The dialysis time had interactive effect on blood phosphorus,iPTH and bone - type alkaline phosphatase(P < 0. 05). The two groups showed significant differences in blood phosphorus,iPTH and bone - type alkaline phosphatase(P < 0. 05). The two groups also showed significant differences in blood phosphorus,iPTH and bone - type alkaline phosphatase 3 months,6 months,9 months and 12 months after dialysis( P < 0. 05). The blood phosphorus,iPTH and bone - type alkaline phosphatase at different time showed significant differences( P < 0. 05). The dialysis time had no interactive effect on KT/ V and URR(P > 0. 05). The survival rate in group A and group B was 90. 0% (18 / 20)and 75. 0%(15 / 20),respectively,and the difference was not significant(χ2 = 0. 69,P = 0. 41). Correlation analysis showed that blood calcium was positively correlated with iPTH(r = 0. 926,P = 0. 03),and blood phosphorus and bone - type alkaline phosphatase were both negatively correlated with iPTH(r = - 1. 802, - 0. 833,P < 0. 05). Logistic regression analysis showed that blood calcium,blood phosphorus and bone - type alkaline phosphatase were influencing factors for iPTH(P < 0. 05). Conclusion High flux hemodialysis can reduce iPTH level and improve metabolic disorders of calcium and phosphorus for patients with uremia associated with SHPT.