中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (09): 487-490.doi: 10.3969/j.issn.1671-4091.2013.09.00

• 临床研究 • 上一篇    下一篇

腹膜透析和血液透析对尿毒症患者钙磷代谢影响的临床研究

  

  1. 台州恩泽医疗中心（集团）路桥医院
  • 收稿日期:2013-03-28 修回日期:2013-07-09 出版日期:2013-09-12 发布日期:2013-09-12

Clinical study on calcium-phosphorous metabolism in uremic patients on peritoneal dialysis or hemodialysis

  • Received:2013-03-28 Revised:2013-07-09 Online:2013-09-12 Published:2013-09-12

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摘要： [摘要] 目的 探讨血液透析与腹膜透析对尿毒症患者在钙、磷代谢的影响 。方法 对97例血液透析及45例腹膜透析治疗均超过3个月以上的患者进行血钙、磷及全段甲状旁腺激素测定和比较，并记录当月患者的尿量。结果 血液透析组的高血磷、高甲状旁腺激素和低甲状旁腺激素发生率分别为51.5%、37.1%、8.2%，而腹膜透析组分别为21.3%、17.8%、23.4%，经比较两组有统计学差异。两组患者尿量大于500ml的腹膜透析组占有55.6%、血液透析组6.2%，经比较两组有统计学意义。血液透析组的低血钙、高血钙和低血磷发生率分别为28.9%、23.7%、13.4%，腹膜透析组分别40.4%、31.9%、25.5%，差异无统计学意义。结论 相对于血液透析，尿毒症患者选择腹膜透析能更好地控制钙磷代谢，能更有效地保护残肾功能。

关键词: 血液透析, 腹膜透析, 钙磷

Abstract: Objective To observe the changes of calcium-phosphorous metabolism in patients with peritoneal dialysis or hemodialysis. Methods Serum calcium, phosphorus and parathyroid hormone (PTH) were measured in 45 peritoneal dialysis and 97 hemodialysis patients after the treatments for 0, 3, and 6 months. Their residual urine output was recorded. Patients with higher PTH were treated with calcitriol, and were treated with low calcium (1.25 μmol/l) dialysate for hemodialysis patients. Results At the beginning of the treatments, the prevalence rate of hyperphosphatemia, higher PTH, and lower PTH was 51.5%, 37.1% and 8.2%, respectively, in hemodialysis group, and was 22.2%, 17.8% and 24.4%, respectively, in peritoneal dialysis group, and the residual urine output >500 ml/day was found in 6.2% patients in hemodialysis group, and in 55.6% patients in peritoneal dialysis group, significantly different between the two groups. In hemodialysis and peritoneal dialysis groups, serum PTH decreased after the treatment with calcitriol and low calcium dialysate for 3 and 6 months (F=23.803 and 4.9896, respectively, P＜0.05). In hemodialysis group, serum calcium was lower than that before the treatment (F=19.879, P＜0.05). Conclusion For uremic patients, peritoneal dialysis was better than hemodialysis in maintenance of normal calcium phosphorus metabolism and protection of residual renal function. Appropriate diet, low calcium dialysate, and calcitriol therapy should be considered for improvement of calcium-phosphorus metabolism in dialysis patients.

Key words: Hemodialysis, Peritoneal dialysis, Calcium, Phosphorus