刘正刚++史峰++任善儿

[摘要] 目的 觀察常用血液净化方法对维持性血液透析患者血清甲状旁腺素（PTH）的清除效果。 方法 选取我院2013年1月～2016年1月收治的50例维持性血液透析患者为研究对象，通过电脑随机分组的方式，分为治疗组和常规组，每组患者均为25例。常规组采用血液透析（HD）治疗，而治疗组给予血液灌流联合血液透析（HP+HD）治疗。比较两组患者在治疗前后临床症状改善情况、感觉神经传导速度（SCV）及生化指标水平（PTH、C反应蛋白以及β2微球蛋白）变化。 结果 HD+HP组显效22例，有效24例，无效4例，总有效率为92.0%；HD组显效14例，有效14例，无效22例，总有效率为56.0%。HD+HP组有效率明显高于HD组，且比较差异有统计学意义（χ2=12.439，P<0.05）；HD组感觉神经传导速度较前均有所增加，但比较差异无统计学意义（P>0.05），HD+HP组治疗后各组神经传导速度均明显增加且差异有统计学意义（P<0.05）；HD+HP组治疗后C反应蛋白（CRP），PTH以及β2-MG等水平明显降低，与治疗前及HD组治疗后比较差异有统计学意义（P<0.05）。 结论 联合血液灌流和血液透析清除维持性血液透析患者血清甲状旁腺素的效果较好，值得临床广泛应用及推广。

[关键词] 血液净化；血液透析；血液灌流；甲状旁腺素；清除

[中图分类号] R692.5 [文献标识码] A [文章编号] 2095-0616（2017）07-246-04

Study on commonly used blood purification in maintaining clearance effect of serum parathyroid hormone of patients with hemodialysis

LIU Zhenggang SHI Feng REN Shan'er

Department of Nephrology， Dalang Hospital of Dongguan， Guangdong， Dongguan 523770， China

[Abstract] Objective To observe the commonly used blood purification in maintaining clearance effect of serum parathyroid hormone （PTH） of patients with hemodialysis. Methods 50 patients with maintenance hemodialysis who were admitted to our hospital from January 2013 to January 2016 were selected as research objects. They were randomly divided into the treatment group and the general group according to randomized grouping by computer， with 25 in each group. The general group was treated by hemodialysis （HD） while the treatment group was treated by hemoperfusion combined with hemodialysis （HP + HD）. Improvements of clinical symptoms， sensory nerve conduction velocity （SCV） and biochemical indexes （PTH， C-reactive protein and β2 microglobulin） before and after treatment of patients in two groups were compared. Results In the HD + HP group， there were 22 cases with marked effect and 4 cases with no effect. The total effective rate was 92.0%. In the HD group， there were 14 cases with marked effect， 14 cases with effect and 22 cases with no effect. The total effective rate was 56.0%. Effect rate of the HD + HP group was significantly higher than that of the HD group. The comparative difference had statistical significance （χ2=12.439， P<0.05）. Sensory nerve conduction velocity of the HD group was increased compared with before and the comparative difference had no statistical significance （P>0.05）. After treatment of HD + HP， sensory nerve conduction velocities of two groups were both significantly increased and the difference was statistical significant （P<0.05）. Differences in levels of C-reactive protein （CPR）， PTH and β2-MG after and after treatment of the HD + HP group had statistical significance （P<0.05）. Conclusion Hemoperfusion combined with hemodialysis in maintaining clearance effect of serum parathyroid hormone of patients with hemodialysis has a good effect， which is worthy of widely clinical application and promotion.

[Key words] Blood purification； Hemodialysis； Hemoperfusion； Parathyroid hormone； Clearance

长期透析患者60%以上有周围神经病变，严重影响透析患者的生活质量。其发生机制不明，目前认为主要与神经毒素长期刺激有关，尤其是中大分子毒素[1-2]。近年来大分子物质如甲状旁腺素（PTH）等对血液透析患者的影响得到重视，发现其与透析患者炎症反应、神经病变和心血管事件等有关[3-5]。普通血液透析（HD）对小分子物质清除好，但对于中大分子的毒性物质清除效果差，致其长期在体内蓄积，导致周围神经病变的发生[6]。对于并发周围神经病变的血液透析患者，我们采用血液灌流（HP）联合血液透析治疗，观察治疗前后甲状旁腺素（PTH）的变化，观察其对尿毒症周围神经病变的治疗作用，并探讨其可能机制，以期为血液透析患者周围神经病变的治疗机制提供依据。……