邓真真 陈铖

【摘要】 目的：探讨不同血液净化模式对患者冠状动脉钙化及对血清软骨寡聚基质蛋白（COMP）与血清成纤维细胞生长因子-23（FGF-23）表达的影响，以期指导未来血液净化模式的合理選择。方法：选取2018年5月-2020年4月于本院完成血液净化治疗的105例患者的临床资料进行回顾性分析。根据血液净化模式不同将其分为HD组（32例，血液透析）、HDF组（40例，血液透析滤过）与HP组（33例，血液灌流）。比较透析前、透析3个月、透析结束时，三组血清COMP、FGF-23表达水平、冠状动脉钙化积分、血磷、血钙、血红蛋白及血尿素氮。结果：三组透析过程中血清COMP、FGF-23表达与冠状动脉钙化积分均呈下降趋势，其中HP组血清COMP、FGF-23表达与冠状动脉钙化积分均较低，差异均有统计学意义（P<0.05）。三组透析过程中血磷与血尿素氮水平均呈下降趋势，且血钙与血红蛋白均呈升高趋势，其中HP组血钙与血红蛋白水平较高，血磷与血尿素氮较低，差异均有统计学意义（P<0.05）。三组各种并发症发生率比较，差异均无统计学意义（P>0.05）。结论：血液透析、血液透析滤过及血液灌流三种血液净化模式均可有效改善患者的冠状动脉钙化现象，其中血液灌流净化模式获益最佳，更利于改善患者冠状动脉钙化情况，且安全性较高。建议临床可根据患者个体差异选择合适的血液净化模式，若条件允许可首选血液灌流净化模式，旨在提高患者临床获益，并保障治疗安全性。

【关键词】 冠状动脉钙化 血液透析 血液透析滤过 血液灌流 血清成纤维细胞生长因子-23 血清软骨寡聚基质蛋白

[Abstract] Objective： To investigate the effects of different blood purification modes on coronary artery calcification and on the expression of serum cartilage oligomer matrix protein （COMP） and serum fibroblast growth factor-23 （FGF-23）， so as to guide the reasonable selection of blood purification modes in the future. Method： Clinical data of 105 patients completed blood purification treatment in our hospital from May 2018 to April 2020 were retrospectively analyzed. According to different blood purification modes， the patients were divided into HD group （32 cases， hemodialysis）， HDF group （40 cases， hemodiafiltration） and HP group （33 cases， hemoperfusion）. The expression levels of serum COMP， FGF-23， coronary artery calcification score， blood phosphorus， blood calcium， hemoglobin and blood urea nitrogen of the three groups were compared before dialysis， 3 months after dialysis and at the end of dialysis. Result： The expression of serum COMP and FGF-23 and coronary artery calcification score of the three groups showed a decreasing trend during dialysis， and the expression of serum COMP and FGF-23 and coronary artery calcification score in the HP group were lower， the differences were statistically significant （P<0.05）. During dialysis， serum phosphorus and blood urea nitrogen levels in the three groups all showed a decreasing trend， while serum calcium and hemoglobin showed an increasing trend. Among them， serum calcium and hemoglobin levels in the HP group were higher， while serum phosphorus and blood urea nitrogen were lower， the differences were statistically significant （P<0.05）. There was no significant differences in the incidence of various complications among the three groups （P>0.05）. Conclusion： Blood dialysis， hemodialysis filtration and blood perfusion of 3 kinds of blood purification mode can effectively improve the patients coronary artery calcification phenomenon， among which， hemoperfusion purification mode has the best benefit and is more conducive to improving coronary artery calcification in patients with higher safety. It is suggested that the appropriate blood purification mode can be selected according to the individual differences of patients in clinical practice. If conditions permit， the blood perfusion purification mode can be selected as the first choice， aiming to improve the clinical benefit of patients and ensure the safety of treatment.

[Key words] Coronary calcium Hemodialysis Hemodiafiltration Hemoperfusion Serum fibroblast growth factor-23 Serum cartilage oligomeric matrix protein

血液净化是各种肾病相关疾病主要治疗方法之一，目前血液净化模式多样，如血液透析（hemodialysis，HD）、血液透析滤过（hemodialysis filtration，HDF）、血液灌流（hemoperfusion，HP）等，血液净化方式不同，治疗适应的群体对象也不同，各种血液净化模式发挥的治疗作用也不尽相同，因此选择合适的血液净化模式，可以在治疗期间保证患者获取最大效益的同时确保安全[1-2]。……