中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (02): 72-76.doi: 10.3969/j.issn.1671-4091.2016.02.004

• 临床研究 • 上一篇    下一篇

不同血液净化技术的联合应用对维持性血液透析患者矿物质和骨异常的影响

漆映辉1,2,倪兆慧1,曲晓璐2,王小玉2,杜美莲2,张善宝2   

  1. 1. 上海交通大学医学院附属仁济医院肾脏科
    2. 上海浦东新区浦南医院肾内科
  • 收稿日期:2015-10-09 修回日期:2015-12-25 出版日期:2016-02-12 发布日期:2016-02-19
  • 通讯作者: 倪兆慧 profnizh@126.com E-mail:profnizhao@126.com
  • 基金资助:

    上海市浦东新区卫计委学科带头人培养计划附带课题(PDRd2013-07)

Effect of different combinations of blood purification technologies on mineral and bone disorder in maintenance hemodialysis patients

  • Received:2015-10-09 Revised:2015-12-25 Online:2016-02-12 Published:2016-02-19

RichHTML

4

PDF

251

摘要： 目的通过观察不同血液净化方式的联合应用对血液透析患者血清中骨代谢指标及骨质疏松患病率的影响，来评价血液透析方式的不同组合对血液透析患者矿物质和骨异常(mineral and bone disorder，MBD)的影响。方法维持性血液透析患者90 例，随机分为血液透析组(对照组或HD 组)、血液透析加血液透析滤过组(HD+HDF 组)、血液透析加血液灌流组(HD+HP 组)，每组30 例，观察6 个月，比较组内及组间6 个月前后血钙、血磷、全段甲状旁腺激素(intact parathyroid hormone, iPTH)、成纤维生长因子23(fibroblast growth factor23，FGF- 23)、β- I 型胶原羧基末端肽(β- Type I collagen carboxy-terminal peptide，β-CTX)、I 型前胶原氨基末端肽(Type I procollagen amino-terminal peptide，PINP)、骨质疏松患病率等指标的变化来评价不同透析方式的组合对血液透析患者MBD 的影响。结果组内自身前后比较：HD 组血磷[(2.21±0.55)mmol/l vs.(2.64±1.04)mmol/l，t=2.047、P =0.049]、iPTH[(427.7±44.00)pg/ml vs.(452.1±43.00)pg/ml，t=2.140,P =0.038]变化有统计学差异；HD+HDF 组的iPTH 下降有统计学差异[(465.3±43.02)pg/ml vs. (431.0±37.39)pg/ml，t=3.298，P =0.007]；HD+HP 组的iPTH[(457.4±60.01)pg/mlvs.(389.1±29.89)pg/ml,t=5.598,P =0.001)、β-CTX[(2.73 ± 1.16)ng/ml vs.(2.13 ± 1.51)ng/ml，t=2.142，P =0.045]；PINP[(157.92 ± 31.16)ng/mlvs.(140.76± 36.13)ng/ml，t=2.106，P =0.047]；FGF-23[(461.16±101.69)ng/ml vs.(397.30±63.18)ng/ml，t=2.922，P =0.011]下降均有统计学意义。组间比较6 个月后，HD+HDF 组PINP 为(147.33±40.72)ng/ml，HD 组PINP 为(165.32±43.11)ng/ml，二者比较有统计学差异(t=1.969，P=0.048)；HD+HDF 组FGF-23 (465.38 ± 101.36)ng/ml，HD 组FGF-23(403.56±96.81)ng/ml，二者比较HD+HDF 组更低，有统计学差异 (t=2.415，P=0.019)；组间比较6 个月后，HD+HP 组与HD 组比较，血磷[(2.02±0.81)mmol/L vs.(2.64± 1.04)mmol/L,t=3.221，P =0.003]、iPTH[(389.1 ± 29.89)pg/ml vs.(452.1 ± 43.0)pg/ml,t=6.661，P = 0.005]、β- CTX[(2.13 ± 1.51)ng/ml vs.(2.95 ± 1.28)ng/ml,t=2.278，P =0.031]、PINP[(140.76 ± 36.13)ng/ml vs.(165.32 ± 43.11)ng/ml,t=2.339,P =0.028]、FGF- 23[(397.30 ± 63.18)ng/ml vs. (465.38±101.36)ng/ml,t=3.114,P=0.003],上述指标HD+HP 组较HD 组更低，均有统计学意义；组间比 较6 个月后，HD+HP 组与HD+HDF 组比较iPTH 分别为(389.1±29.89)ng/ml、(431.0±37.39)ng/ml，HD+HP 组更低，有统计学意义(t=7.303,P=0.000)。骨质疏松患病率：对照组观察期后骨质疏松和骨量低下的病例数增加，但无统计学意义；HD + HDF 组、HD + HP 组骨质疏松的病例数有减少，亦无统计学意义(P＞0.05)。结论不同的血液透析方式的联合使用对维持性血液透析患者MBD 影响不同；血液透析联合血液透析滤过或血液灌流的治疗方式较单纯血液透析有利MBD 的改善；血液透析联合血液灌流在骨代谢指标的改善方面更具优势。

关键词: 矿物质骨异常, 全段甲状旁腺激素, β-I 型胶原羧基末端肽, I 型前胶原氨基末端肽, 成纤维生长因子23

Abstract: Objective To investigate the effects of different combinations of blood purification technologies on mineral and bone disorder (MBD) in maintenance hemodialysis (MHD) patients through observing their bone metabolism and prevalence of osteoporosis. Methods Ninety MHD patients with chronic kidney
disease (CKD) and MBD were randomly divided into three groups, HD group (hemodialysis, control group, n=30), HD+HDF group (HD and hemodiafiltration group, n=30), and HD+HP group (HD and hemoperfusion, n=30). After the treatment for six months, the changes of serum calcium (Ca), phosphorus (P), intact parathyroid hormone (iPTH), β-type I collagen carboxy-terminal peptide (β-CTX), type I procollagen amino-terminal peptide (PINP), fibroblast growth factor 23 (FGF-23), and prevalence of osteoporosis were compared in the groups and among the 3 groups to evaluate the effects of different combinations of dialysis methods on MHD patients with MBD. Results After the treatment for 6 months, serum P increased in HD group (2.64±1.04 vs. 2.21±0.55 mmol/l, t=2.047, P= 0.049 for serum P; 452.1±43.00 vs. 427.7±44.00 pg/ml, t=2.140, P=0.038 for iPTH); iPTH decreased in HD+HDF group (431.0±37.39 vs. 465.3±43.02 pg/ml, t=3.298, P=0.007); iPTH, β- CTX, PINP, and FGF-23 decreased in HD+HP group (389.1±29.89 vs. 457.4±60.01 pg/ml, t=5.598, P=0.0006 for iPTH; 2.13±1.51 vs. 2.73±1.16 ng/ml, t=2.278, P=0.031 for β-CTX; 140.76±36.13 vs. 157.92±31.16 ng/ ml, t=2.106, P=0.047 for PINP; 397.30±63.18 vs. 461.16±101.69 ng/ml, t=2.922, P=0.011 for FGF-23). After the treatment for 6 months, PINP was lower in HD+HDF group than in HD group (147.33±40.72 vs. 165.32± 43.11 ng/ml, t=1.969, P =0.048); FGF-23, serum P, β-CTX, PINP and iPTH were lower in HD+HP group than in HD group (397.30±63.18 vs. 465.38±101.36 ng/ml t=3.114, P=0.003 for FGF-23; 2.02±0.81 vs. 2.64±1.04 mmol/l, t=3.221, P=0.003 for serum P; 2.13±1.51 vs. 2.95±1.28 ng/ml, t=2.278, P=0.031 for β-CTX; 140.76±
36.13 vs. 165.32±43.11 ng/ml, t=2.339, P=0.028 for PINP; 389.1±29.89 vs. 452.1±43.0 pg/ml, t=6.661, P= 0.005 for iPTH); iPTH was lower in HD+HP group than in HD+HDF group (389.1±29.89 vs. 431.0±37.39 ng/ ml, t=7.303, P=0.000). After the treatments for 6 months, the cases of osteoporosis and bone mass reduction were increased in HD group and were decreased in HD+HDF group and HD+HP group but without statistical significances. Comparison The combined use of different hemodialysis methods has different effects on MBD in MHD patients. HD+HDF and HD+HP are better than HD, and HD+HP is the best for the improvement of MBD.

Key words: Mineral and bone disorder, Intact parathyroid hormone, β-Type I collagen carboxy-terminal peptide, Type I procollagen amino-terminal peptide, fibroblast growth factor23