中国血液净化

›› 2005, Vol. 4 ›› Issue (1): 10-13.

• 论著 • 上一篇    下一篇

不同透析膜对维持性血液透析患者肾性骨病相关因素的影响

谢 飞 王汉民   

  1. 710054 西安，武警陕西省总队医院肾内科(谢飞)710032 西安，第四军医大学西京医院肾内科(王汉民)
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2005-01-12 发布日期:2005-01-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2005-01-12 Published:2005-01-12

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摘要：

目的 探讨不同种类透析膜对维持性血液透析（MHD）患者肾性骨病相关因素，尤其是对全段 甲状旁腺激素（iPTH）、血磷、血钙水平的影响。方法 将慢性肾衰竭MHD伴有高磷血症、高iPTH血症的患者随机分为3组，分别采用醋酸纤维素膜(CA)、聚砜膜(PS)、血仿膜(HE)透析器透析，测定透析前后血磷、血钙、尿素氮及iPTH等，比较不同膜材料透析器初用与复用后毒素的下降率及KT/V值的变化；同时选择正常健康者作为对照组检测血磷、iPTH及血钙的水平。结果 MHD患者透析前血磷、iPTH水平明显高于正常对照组（P<0.01），透析后较透析前显著下降（P<0.01）；透析前血钙明显低于正常对照组（P<0.05），透析后较透析前显著升高（P<0.05）。HE和PS透析后血磷的下降水平均与CA有显著差异（P<0.05）。3种膜材料透析器初用时 KT/V无明显差异，复用后KT/V较初用时均明显下降（P<0.05）；复用后血磷、尿素氮及肌酐的下降率与初用相比差异显著（P<0.05）。结论 应用 CA、PS和HE透析器可使MHD患者透析后iPTH 明显下降，透析器复用后对小分子物质的清除明显下降，HE和PS对血磷的清除能力优于CA，选择对血磷清除能力高的透析器，可能会减轻肾性骨病的发生。

关键词: 血液透析, 透析膜, 钙磷代谢, 甲状旁腺激素

Abstract:

Objective To evalute the effects of different dialyzer membranes on relative factors about renal osteodystrophy (ROD) in maintenance hemodialysis(MHD) patients, especially to observe the changes of intact parathyroid hormone(iPTH), phosphorus and calcium in serum. Methods The MHD patients who were diagnosed ROD with high levels of phosphorus and iPTH were randomly divided into three groups. They received dialysis with different dialyzers of cellulose acetate (CA), hemophan (HE) and polysulfone (PS). The levels of serum iPTH, phosphorus, calcium (Ca), blood urea nitrogen (BUN) and creatinine (Cr) of each group were measured pre-hemodialysis and post-hemodialysis. The decreasing rate of urea, creatinine, phosphorus, iPTH and the level of Ca of each group were calculated and compared by using new and reused dialyzers. The values of KT/V were calculated by measuring the levels of BUN pre-HD and post-HD. The levels of phosphorus, iPTH and Ca in healthy controls were measured as control group. Results The levels of serum phosphorus and iPTH in pre-HD of MHD patients were significantly higher than the control group (P<0.01), but those indexes in post-HD were significantly decreasd than that in pre-HD (P<0.01). The level of serum calcium in pre-HD of MHD patients were significantly lower than the control group (P<0.05) and higher in post-HD (P<0.05). The were significant difference of the descending level of serum phosphorus between the PS and HE groups and CA group (P<0.05) after HD. Compared with the new dialyzers, the value of KT/V was significantly decreased than reused dialyzers (CA group>PS and HE groups, P<0.05), but there were no significant difference befween the first used dialyzers. The descending rates of serum phosphorus, BUN and Cr in reused dialyzers were significantly different with the first used dialyzers in all three groups (P<0.05). Conclusion Applying of CA, PS and HE dialyzers may significantly decrease iPTH in MHD patients after HD. The clearance rate of small molecules significantly decreased using reused dialyzers. The clearance rate of serum phosphorus using HE and PS dialyzers is obviously higher than CA dialyzer. This higher the cearence may reduce occurrence of osteodystrophy.

Key words: Hemodialysis membrane, Calcium and phosphorus metabolism, Parathyroid hormone 

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