HDF联合小剂量骨化三醇治疗肾性骨病临床分析
| 作者: |
1刘宇,
1王英东
1 中国医科大学附属第一医院，沈阳 110000 |
| 通讯: |
王英东
Email: sunwang99@sina.cn |
| DOI: | 10.3978/j.issn.2095-6959.2015.07.029 |
摘要
目的：研究肾性骨病(renal osteodystrophy，ROD)患者应用血液透析滤过(hemodiafiltration，HDF)与小剂量骨化三醇进行联合治疗的临床效果。方法：回顾分析我院自2011年11月至2013年11月以来，于我科治疗的112例ROD患者临床资料，依据治疗方式将其分为研究组与对照组，每组56例，研究组应用HDF与小剂量骨化三醇进行联合治疗，对照组应用高通量血液透析(high throughputhemodialysis，HFHD)与大剂量骨化三醇进行联合治疗，两组规律治疗16周后，观察对比两组治疗前后SCr、BUN、血清白蛋白(serum albumin，ALB)、ROD症状评分的改变情况，两组治疗前后血清钙、磷、钙磷乘积、甲状旁腺素(parathyroid hormone，iPTH)的改变情况，以及两组治疗前后骨源性碱性磷酸酶(bone alkaline phosphatase，BAP)的改变情况。结果：研究组治疗前BAP水平与对照组相较，不具差异(P>0.05)，研究组治疗后BAP水平与对照组相较，呈明显差异(P<0.05)。研究组治疗前后SCr、BUN、ALB、ROD症状评分与对照组相较，均不具差异(P>0.05)，但两组治疗后ROD症状评分与治疗前相较，均呈明显差异(P<0.05)，在研究组骨化三醇应用剂量与对照组呈明显差异的情况下，未因血钙偏高而停药。研究组治疗前血清钙、磷、钙磷乘积、iPTH水平与对照组相较，均不具差异(P>0.05)，研究组、对照组治疗后血钙与治疗前相较，均有降低，但不具差异(P>0.05)，研究组治疗后血磷降低明显，与对照组相较，呈明显差异(P<0.05)，研究组治疗后血钙磷乘积、iPTH水平与对照组相较，均呈明显差异(P<0.05)。结论：ROD患者应用HDF、小剂量骨化三醇进行联合治疗，同应用HFHD、大剂量骨化三醇进行联合治疗对比，疗效相当，但前者能够降低骨化三醇对机体BAP、iPTH水平以及钙磷代谢的干扰，更适合在临床推广。
关键词：
肾性骨病
血液透析滤过
小剂量
骨化三醇
疗效
Comparison of HDF combined with small dose of ossification in three alcohol and high flux hemodialysis combined with large dose of ossification in three alcohol for renal osteodystrophy effect
CorrespondingAuthor: Wang Yingdong Email: sunwang99@sina.cn
DOI: 10.3978/j.issn.2095-6959.2015.07.029
Abstract
Objective: To study the renal osteodystrophy (ROD) with hemodiafiltration (HDF) clinical effect of combined treatment with small dose of ossification in three alcohol. Methods: retrospective analysis of our hospital from 2011 November to 2013 since November, clinical data of 112 cases with ROD in our department treated according to treatment, can be divided into study group and control group, 56 cases in each group, the study group using HDF with small dose of ossification in three alcohol combination therapy, the control group using high throughput hemodialysis (HFHD) combination therapy with large dose of ossification in three alcohol, two sets of rules after 16 weeks of treatment, observe and compare the two groups before and after treatment of SCr, BUN, serum albumin (ALB), change the ROD symptom score of the two groups before and after treatment, serum calcium, phosphorus, calcium phosphorus product, parathyroid hormone (iPTH) changes of the two groups before and after treatment, and BAP (BALP) changes. Results: the study group before treatment, the level of BAP compared with the control group, with no difference (P>0.05), the study group after treatment, the level of BAP compared with the control group, showed a significant difference (P<0.05). Before and after the treatment, the BUN research group SCr, ALB, ROD and the control group compared with the symptom score, are not significant difference (P>0.05), but the score and the treatment of ROD symptoms in two groups after treatment than before, showed significant difference (P<0.05) in the study group, three alcohol ossification application dose and control group was obviously different circumstances, not due to high calcium and discontinuation. The study group before treatment, serum calcium, phosphorus, calcium phosphorus product, the level of iPTH and the control group were compared, with no difference (P>0.05), the study group, group after treatment compared with before treatment, serum calcium and reduces both the control, but no difference (P>0.05), the study group after treatment significantly reduced the serum phosphorus, compared with the control group, showed a significant difference (P<0.05), the study group after treatment, calcium phosphorus product, the level of iPTH and the control group in comparison, were significantly difference (P<0.05). Conclusion: Patients with ROD using HDF, a small dose of ossification in three alcohol combined therapy, with the application of HFHD, a large dose of ossification in three alcohol for the treatment of patients with contrast, quite, but the former can reduce the ossification in three alcohol on the BAP, iPTH levels and calcium and phosphorus metabolism disturbance, more suitable for clinical.