慢性肾衰竭患者血清甲状旁腺激素和瘦素水平在高通量血液透析前后变化的研究.DOCVIP

临床医学论文-慢性肾衰竭患者血清甲状旁腺激素和瘦素水平在高通量血液透析前后变化的研究 ??????????????? 作者：张剑彬，马伟，童汝雁，黄先池?? 【摘要】? 目的 探讨高通透量透析对慢性肾衰竭(CRF)患者血清甲状旁腺激素（iPTH）和瘦素(leptin)水平的影响及其两者的相互关系。方法 测定15例CRF高通量透析患者(HPD组)和15例CRF常规透析患者(CHD组)透析前后血清iPTH、leptin水平及肾功能指标（BUN、Cr）。比较两组各项检测指标水平的下降率，并分析高通量透析前、后血清iPTH和Leptin水平的相互关系。结果 CHD组透析后血清iPTH、leptin水平与透析前无明显变化(P0.05)，而HPD组明显降低(P＜0.01)；但两组对小分子尿毒症毒素的清除率差异均无显著性(P0.05)；HPD组透析前后血清iPTH和Leptin水平呈负相关（r分别为-0.730和-0.665，P0.05），且透析后血清iPTH下降率小于leptin下降率（P0.05）。结论 高通量透析能很好地清除CRF患者血清iPTH和leptin；高血清leptin水平与高血清iPTH水平两者可能具有相互桔抗作用。 【关键词】? 肾功能衰竭，慢性；肾透析；受体，甲状旁腺激素；瘦素 　　Abstract:? Objective? To research the correlation between serum iPTH and leptin and their level changes in patients undergoing high-permeable dialysis (HPD).? Methods? A radio-immunity assay(RIA) was used to detect the serum iPTH levels and leptin concenration in 15 patients with coronary renal failure (CRF) undergoing HPD as well as in 15 patients with CRF undergoing conventional hemodialysis (CHD) before and after hemodialysis.Serum BUN and Cr concentration in both groups were determined by auto-biochemical instrument.The clearing of all parameters which we study were compared，and the correlation between serum iPTH and leptin in patients given with HPD were analyzed.? Results? In CHD group，no dominant changes of serum iPTH and leptin concentration were found before and after hemodialysis (P0.05).But serum iPTH and leptin concentration reduced after HPD (P0.01).No dominant variation of clearing of mini-molecular uremic toxin in both groups were found (P0.05).Inverse associations between serum iPTH and leptin were found whenever HPD or not (r=-0.730 and -0.665，respectively，P0.05).The clearing of serum iPTH is lower than that of serum leptin after HPD (P0.05).? Conclusion? HPD can reduce effectively serum iPTH and leptin concentration，but not CHD.The inverse correlation between serum leptin level and iPTH discovered that hyperleptinemia may have resistance to high serum iPTH concentration.??? 　　Key words:? renal failure