目的 探讨血液灌流(hemoperfusion,HP)串联血液透析滤过(hemodiafiltration,HDF)对尿毒症合并血管钙化的防治效果。方法 慢性肾衰竭尿毒症患者60例随机分为血液灌流串联血液透析组(A组)、单纯血液透析组(B组);分别于首次治疗前后及治疗24周测定两组甲状旁腺素(parathyroid hormone,PTH)、成纤维细胞生长因子23(fibroblast growth factor23,FGF23)、软骨寡聚集蛋白(cartilage olgomeric matrix protein,COMP)、骨形成蛋白-2(bone morphogenetic protein 2,BMP-2)、血清钙(calcium, Ca2+)、血磷(phosphorus, P3+);X线片评估首次治疗前及治疗后24周胸部、骨盆、双手正位血管钙化情况;多元Logistic 回归分析血管钙化的危险因素。结果 两组治疗前PTH、FGF23、COMP、BMP-2、P3+等比较差异均无统计学意义(P>0.05);A组首次治疗前、后比较,末次治疗后与首次治疗后比较,差异有统计学意义(P<0.05);多元Logistic 回归分析结果显示,血清中PTH、FGF23、COMP、BMP-2、P3+等为血管钙化发生的相对危险因素。结论 血液灌流串联血液透析滤过能有效防治尿毒症合并血管钙化。
Abstract
Objective To investigate the effect of hemoperfusion(HP) combined with hemodialysis-filtration(HDF) on prevention and control of vascular calcification in uremic patients. Methods From this hospital we recruited 60 patients with chronic renal failure and uremia, randomly divided into 2 groups. Group A underwent hemoperfusion(HP) combined with hemodialysis-filtration(HDF); groups B received traditional hemodialysis(HD). Comparative analysis of the correlation among different indexes before and after first time treatment and finished at 24 weeks, such as parathyroid hormone(PTH), fibroblast growth factor23(FGF23), cartilage olgomeric matrix protein(COMP), bone morphogenetic protein 2(BMP-2),calcium(Ca2+),phosphorus(P3+). Vascular calcification was evaluated by chest, pelvis and hands X-ray examination before first time treatment and after 24 weeks of treatment. Analysis of the correlation among different indexes and multivariate logistic regression analysis of risk factors of vascular calcification were carried out. Results Comparing group A and group B before treatment, there were no statistically significant differences in PTH, FGF23, BALP, COMP, BMP-2, P3+ (P>0.05). In group A ,compared between before and after the first time of treatment, and between the first time of treatment and the last time of treatment there was statistically significant difference (P<0.05). Multivariate logistic regression analysis showed that PTH, FGF23, BALP , COMP, BMP-2 ,P3+ and phosphorus are risk factors of vascular calcification . Conclusions Hemoperfusion(HP)combined with hemodialysis-filtration(HDF) can effectively prevent uremia accompanied by vascular calcification.
关键词
血液灌流 /
血液透析滤过 /
尿毒症 /
血管钙化
Key words
hemoperfusion /
hemodialysis-filtration /
uremia /
vascular calcification
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