血液透析联合结肠透析治疗尿毒症患者高磷血症的临床研究∗

摘要

目的：了解血液透析( HD)联合结肠透析( CD)治疗尿毒症患者高磷血症的疗效,为血透患者控制高磷血症提供新的治疗方法。方法：入选维持性血液透析( MHD)伴高磷血症患者60例,随机分为单纯性血液透析组( HD组)30例,血液透析联合结肠透析组(HD+CD组)30例；HD组维持每周3次血透,每次4 h,HD+CD组在HD组基础上加用每周3次,每次1 h的结肠透析。总疗程为12周。观察治疗前后两组患者食欲、皮肤瘙痒及骨痛临床症状的改善情况。分别检测两组患者治疗前及治疗后肾功能、KT/V、血钙( Ca2+)、血磷( P3-)、血清全段甲状旁腺激素( iPTH)、1,25二羟维生素 D [1,25(OH)2D3]及成纤维细胞生长因子-23(FGF-23)。结果：治疗后,HD+CD组较HD组食欲、皮肤瘙痒及骨痛的临床症状改善显著(P<0.05)。 HD组治疗前后肾功能、KT/V、Ca2+、P3-、1,25(OH)2D3及 FGF-23差异无统计学意义(P>0.05)。 HD+CD组透析前后Ca2+及1,25(OH)2D3差异无统计学意义(P>0.05),但P3-、iPTH及FGF-23有明显下降(P<0.05)；HD+CD组较HD组治疗后P3-、iPTH、FGF-23水平显著降低,差异有统计学意义(P<0.05)。结论：对于尿毒症伴高磷血症患者,结肠透析可有效改善患者高磷血症。%Objective:Observing the effect of hemodialysis combined with colon dialysis in uremic patients with hyperphos-phatemia, in order to provide a new treatment method for uremic patients with hyperphosphatemia. Methods:A total of 60 uremic pa-tients with hyperphosphatemia were randomly divided into HD group and HD+CD group, with each group of 30 patients. Patients for HD group maintained hemodialysis for 3 times per week and 4 hours per each time, while patients for HD+CD group maintained colon dialysis for 3 times per week and 1 hours per each time at the basic of HD group. The total course of treatment was 12 weeks. Observe the improvement of appetite, skin itching symptoms and bone pain. The renal function, serum calcium ( Ca2+) , phosphorus ( P3-) , serum parathyroid hormone (iPTH), 1,25(OH)2D3 and FGF-23 were compared before and after treatment. Results:The appetite, skin itching symptoms and bone pain of HD+CD group improved significantly than HD group (P<0. 05). No distinctly difference of renal function, KT/V, Ca2+, P3-, 1,25(OH)2D3 and FGF-23 in HD group was found at the end of the study compared with those at the beginning of the study (P>0. 05). There is no significantly difference of renal function, KT/V, Ca2+, 1,25(OH)2D3 in HD+CD group when compared with those before the study, while Ca2+, P3- and FGF-23 decreased significantly (P<0. 05). After the 12-week treatment, Ca2+, P3- and FGF-23 of HD+CD group were obviously lower than the data of HD group (P<0. 05). Conclusion:Colon dialysis has a valid effect for uremic patients with hyperphosphatemia to remove blood phosphorus.