血液透析联合血液灌流对维持性血液透析患者继发性甲状旁腺功能亢进的影响

发布时间：2018-03-14 02:14

本文选题：血液透析　切入点：血液灌流　出处：《河北大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究通过观察血液透析联合血液灌流对维持性血液透析患者继发性甲旁亢(SHPT)的治疗,分析两组治疗后对相关生化指标包括血钙(Ca)、血磷(P)、钙磷乘积、尿素氮(BUN)、血肌酐(Cr)、全段甲状旁腺激素(iPTH)、β2-微球蛋白(β2-MG)、胱抑素C(CysC)的影响,计算尿素清除指数(Kt/V);并监测血液透析联合血液灌流治疗后iPTH的变化情况,探讨再次行血液透析联合血液灌流治疗的周期,为选择血液透析联合血液灌流治疗SHPT提供理论依据。方法:选取我院血液净化中心维持性血液透析合并SHPT的患者40例,并将其随机分为2组:血液透析联合血液灌流(HD+HP)组20例和常规血液透析(HD)组20例。比较两组患者治疗前后血钙(Ca)、血磷(P)、钙磷乘积、全段甲状旁腺激素(iPTH)、尿素氮(BUN)、血肌酐(Cr)、β2-微球蛋白(β2-MG)、胱抑素C(CysC)的变化情况,计算尿素清除指数(Kt/V);并观察HD+HP组患者治疗后第7天、第14天、第28天全段甲状旁腺素(iPTH)、血红蛋白(Hb)、血小板(PLT)、白蛋白(Alb)的变化情况。统计学分析采用SPSS16.0软件完成;计量资料以(?)±s表示,组间比较采用t检验;计数资料以(n,n%)表示,组间比较采用χ~2检验;单样本区间比较采用方差分析,并以P0.05为差异有统计学意义。结果:治疗后两组的血P、钙磷乘积、BUN、Cr水平均较治疗前明显下降(P0.05),血Ca水平均较治疗前明显上升(P0.05);两组治疗后的血Ca、P、钙磷乘积、BUN、Cr水平比较,差异均无统计学意义(P0.05)。HD+HP组治疗后iPTH、β2-MG、CysC水平均较治疗前下降,差异具有统计学意义(P0.05);治疗后HD+HP组iPTH、β2-MG、CysC水平(268.05±100.16、40.31±14.75、6.56±2.14)均低于HD组(435.28±147.17、66.80±25.39、9.85±2.58),差异有统计学意义(P0.05)。第14天、第28天iPTH水平均高于第1天治疗后iPTH水平,差异均有统计学意义(P0.05);进一步两两比较发现,第14天iPTH水平与第7天iPTH水平相比,差异无统计学意义(P0.05);第28天iPTH水平高于第14天iPTH水平,差异有统计学意义(P0.05)。结论:1.HD+HP清除iPTH、β2-MG、CysC优于HD。2.建议维持性血透SHPT患者可于2周再次行HD+HP治疗。
[Abstract]:Objective: to observe the therapeutic effect of hemodialysis combined with hemoperfusion on secondary hyperthyroidism parathyroid hyperthyroidism (SHPTT) in patients with maintenance hemodialysis. The effects of bun, creatinine, parathyroid hormone, 尾 2-MGG, cystatin cystatin CysCon were calculated, and the change of iPTH after hemodialysis combined with hemoperfusion was monitored, and the effect of urea nitrogen bun, creatinine creatinine (Cr), total parathyroid hormone (PTH), 尾 2-microglobulin (尾 2-MGG), cystatin cystatin (Cy) CysC were calculated. To explore the cycle of hemodialysis combined with hemoperfusion therapy, and to provide the theoretical basis for selecting hemodialysis combined with hemoperfusion therapy for SHPT. Methods: 40 patients with maintenance hemodialysis combined with SHPT in our blood purification center were selected. The two groups were randomly divided into two groups: hemodialysis combined with hemoperfusion with HD (n = 20) and routine hemodialysis (HD) (n = 20). The changes of total parathyroid hormone iPTHN, urea nitrogen bun, creatinine creatinine, 尾 2-MGG, cystatin cystatin CysC were calculated, and the urea clearance index (KT / V) was calculated, and the 7 and 14 days after treatment in HD HP group were observed. On the 28th day, the changes of parathyroid hormone (PTH), hemoglobin (HB), platelets (PLT), Alb (Alb) were analyzed by SPSS16.0 software. ) 卤s, t-test was used for inter-group comparison, and 蠂 ~ 2 test was used for inter-group comparison, and ANOVA was used for single-sample interval comparison. Results: after treatment, the blood P, Ca and P products of the two groups were significantly lower than those before treatment (P 0.05), the blood Ca levels were significantly higher than those before treatment (P 0.05), and the levels of calcium and phosphorus in the blood of the two groups after treatment were significantly higher than those before treatment, and the levels of BUNCr in the blood of the two groups after treatment were significantly higher than those before treatment, and the levels of BUNCr in the blood of the two groups after treatment were higher than those before treatment. There was no significant difference in the levels of iPTHand 尾 2-MGfCysC in HD HP group after treatment, and the difference was statistically significant (P 0.05), and the level of iPTH, 尾 2-MGG CysC in HD HP group was 268.05 卤100.160.160.31 卤14.756.56 卤2.14), which was significantly lower than that in HD group (435.28 卤147.176.80 卤25.396.80 卤25.39.85 卤2.58g / d). The level of iPTH on the 28th day was higher than that on the first day after treatment, and the difference was statistically significant (P 0.05). Further comparison showed that the level of iPTH on the 14th day was higher than that on the 7th day, and the level of iPTH on the 14th day was higher than that on the 7th day. There was no significant difference (P 0.05); the level of iPTH on the 28th day was higher than that on the 14th day, and the difference was statistically significant (P 0.05). Conclusion: 1. HD HP is superior to HD.2. it is suggested that the patients with maintenance hemodialysis SHPT should be treated with HD HP again at 2 weeks.
【学位授予单位】：河北大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5;R582.1

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