不同血液透析方法对维持性血液透析患者钙磷代谢影响.docVIP

不同血液透析方法对维持性血液透析患者钙磷代谢的影响 　　doi：10.3969/j.issn.1007-614x.2013.21.60 　　摘 要 目的：分析慢性肾衰竭维持性血液透析患者钙磷代谢状况，研究不同血液透析方法对钙磷代谢的影响，为临床治疗提供依据。方法：收治维持性血液透析患者125例，将患者分为单纯血液透析组（单纯HD组）及混合透析组，对这两组的血钙、血磷、甲状旁腺激素（iPTH）、钙磷乘积等指标进行统计学分析。结果：125例患者血钙平均值2.14±0.29mmol/L，血钙1.78mmo1/L 67例（53.6%），iPTH平均值315.76±371.75pg/ml，iPTH300pg/ml 45例（36%），其中iPTH1000pg/ml 8例（6.4%）。与单纯HD组相比，混合透析组血钙、血磷、钙磷乘积及iPTH等指标明显低于单纯HD组，差异有统计学意义（P0.05）。结论：有相当比例的血液透析患者未能满意的控制钙磷代谢紊乱及其继发性甲状旁腺功能亢进，应进一步加强透析，可联合血液透析滤过及血液灌流等透析方式来加强对钙磷及iPTH的控制。 　　关键词 钙磷代谢 甲状旁腺素 继发性甲状旁腺功能亢进 肾性骨病 血液透析 　　Abstract Objective：To evaluate the risk of abnormal calcium and phosphorus metabolism in patients with maintenance hemodialysis，so as to gain insight in the status of the bone metabolism and bone disease of those patients and provide evidence to clinical treatment.Methods：Clinical materials of 125 maintenance hemodialysis patients from No2 Hospitalof Fuzhou City during January 2013 to July 2013 were studied.Investigate the bio- chemical data of those maintenance hemodialysis patients，who were divided into 2 groups as hemodialysis group（HD group） and hemodialysis with hemonoperfusion or hemodiafiltration group（mixed group）.Results：The average blood calcium density of 125 patients is 2.14±0.29mmol/L.About 32.8% of the patients have values lower than 2.1mmol/L.The average blood phosphoms density is 2.01±0.77mmol/L.About 53.6% of the patients have values higher than 1.78mmol/L.The average iPTH density is 315.76±371.75pg/ml.About 44% of the patients have values lower than 150 pg/ml，and 36% higher than300 pg/ml.About6.4% of the patients have values higher than 1000 pg/ml.The serum calcium，phosphorus and iPTH in mixed group patients is better than HD group patients（P0.05）.Conclusion：There is still considerable proportion of maintenance hemodialysis patients with abnormal mineral metabolism and secondary hyperparathyroidism.We can combine hemodialysis with hemonoperfusion and hemodiafiltration to increase the dialysis and better control serum calcium，pho