不同血液净化方式对维持性血液透析患者钙磷代谢的影响

发布时间：2018-01-02 04:10

本文关键词：不同血液净化方式对维持性血液透析患者钙磷代谢的影响　出处：《皖南医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨低通量血液透析(Low flux hemodialysis,LFHD)、高通量血液透析(High flux hemodialysis,HFHD)以及血液透析滤过(Hemodiafiltration,HDF)三种不同血液净化方式对维持性血液透析(Maintence hemodialysis,MHD)患者的钙、磷、甲状旁腺激素(Parathyroid hormone,PTH)等生化检测指标的影响,为MHD患者钙磷代谢紊乱及继发性甲状旁腺功能亢进症(Secondary hyperparathyroidism,SHPT)的治疗探索一种最佳透析方式,为改善其临床症状、提高生活质量以及远期生存率提供临床应用价值。方法:严格按照入选标准和排除标准选取2015年01月至2016年12月在皖南医学院附属弋矶山医院血液净化中心规律接受MHD治疗的尿毒症患者60例,根据透析方式的不同分为LFHD组、HFHD组、HDF+LFHD组3组,每组20例,观察1年,比较各组患者1年前后血钙、血磷、PTH等检测指标的变化,探讨不同血液净化方式对MHD患者血钙、血磷、PTH的影响。结果:1.三组组内自身比较:三组治疗前后,血钙水平变化程度,差异均无统计学意义(P0.05)。LFHD组治疗前后,血磷、PTH水平变化程度,差异无统计学意义(P0.05);HFHD组和HDF+LFHD组治疗前后,血磷、PTH水平均下降,差异有统计学差异(P0.05)。2.三组组间比较:三组组间血钙下降率相比,差异无统计学意义(P0.05)。组间血磷下降率相比:LFHD组分别与HFHD组和HDF+LFHD组相比,差异有统计学意义(P0.05);HFHD组(血磷下降率为15.88±22.65)与HDF+LFHD组(血磷下降率为10.68±26.68),差异无统计学意义(P0.05)。组间PTH下降率相比:LFHD组分别与HFHD组及HDF+LFHD组相比,差异有统计学意义(P0.05);HFHD组(PTH下降率为28.28±27.85)与HDF+LFHD组(PTH下降率为35.41±30.14)相比,差异无统计学意义(P0.05)。结论:HFHD和HDF较LFHD均能有效降低血磷、PTH,纠正MHD患者的钙磷代谢紊乱,从而有效治疗SHPT。
[Abstract]:Objective: To investigate the low flux hemodialysis (Low flux, hemodialysis, LFHD), high flux hemodialysis (High flux, hemodialysis, HFHD) and hemodiafiltration (Hemodiafiltration, HDF) three different blood purification methods on hemodialysis (Maintence hemodialysis, MHD) with calcium, phosphorus, parathyroid hormone (Parathyroid hormone. PTH) the influence of biochemical index for patients with MHD, calcium and phosphorus metabolism and secondary hyperparathyroidism (Secondary hyperparathyroidism, SHPT) treatment to explore a best way for dialysis, improve the clinical symptoms, improve the quality of life and clinical value of long-term survival rate. Methods: according to inclusion criteria and exclusion the standard from 2015 01 months to December 2016 in Wangnan Medical College affiliated rocky 60 uremia patients treated with MHD blood purification center. The hospital, According to different dialysis methods for the LFHD group, HFHD group, HDF+LFHD group, 3 groups, 20 cases in each group, the observation group compared with 1 years, 1 years before and after the blood calcium, blood phosphorus, PTH detection index, to explore different ways of blood purification on MHD serum calcium, serum phosphorus, the effect of PTH. Results: 1. the three groups in their comparison: three groups before and after treatment, the degree of change in blood calcium levels, there were no significant differences (P0.05) before and after treatment in group.LFHD, blood phosphorus, changes of PTH level, the difference was not statistically significant (P0.05); HFHD group and HDF+LFHD group before and after treatment of blood phosphorus and PTH levels were decreased, the difference is statistical difference (P0.05) between the three groups: comparison of.2. between the three groups of blood calcium decreased compared to the rate, there was no statistically significant difference between groups (P0.05). Serum phosphorus decreased compared to LFHD group respectively compared with HFHD group and HDF+LFHD group, the difference was statistically significant (P0.05); HFHD group (the blood phosphorus decline rate 15.88 + 22.65) and HDF +LFHD group (the blood phosphorus decline rate is 10.68 + 26.68), there was no statistically significant difference between groups (P0.05). The decline rate of PTH compared to LFHD group compared with HFHD group and HDF+LFHD group, the difference was statistically significant (P0.05); HFHD group (the decline rate of PTH was 28.28 + 27.85 (PTH) and HDF+LFHD group decreased rate of 35.41 + 30.14) compared to the difference was not statistically significant (P0.05). Conclusion: HFHD and HDF LFHD can effectively reduce serum phosphorus, PTH, calcium and phosphorus metabolism correction in MHD patients, which is effective in the treatment of SHPT.

【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5

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