血流灌注加血液透析治疗尿毒症继发性甲状旁腺功能亢进症的疗效观察

【摘要】  目的 观察血流灌注加血液透析治疗尿毒症继发性甲状旁腺功能亢进症的疗效。方法 将尿毒症继发性甲状旁腺功能亢进患者46例随机分成观察组及对照组，各23例，观察组予1周3次血液灌流串联血液透析治疗；对照组行常规1周3次血液透析治疗。1周后，比较两组血清全段甲状旁腺激素（PTH）和皮肤瘙痒、睡眠及肌无力等症状改善情况。结果 血流灌注加血液透析治疗组1周后患者的甲状旁腺激素显著下降，与对照组比较差异有统计学意义（P＜0.05)，且皮肤瘙痒、肌无力等症状好转，睡眠改善。结论 1周3次血液灌流加血液透析可明显降低尿毒症患者的PTH浓度，较快改善患者症状，表明血流灌注串联血液透析治疗尿毒症继发性甲状旁腺功能亢进症有比较满意的疗效。

【关键词】  血液灌流 血液透析 尿毒症 继发性甲状旁腺功能亢进症

【Abstract】Objective  To investigate the effects of combined hemoperfusion and hemodialysis in uremia patients complicated with secondary hyperparathyroidism. Methods  46 uremia patients complicated with secondary hyperparathyroidism were randomly devided into two groups:23 patients were treated with combined hemoperfusion and hemodialysis 3 times in one week ;the other 23 patients were treated with hemodialysis 3 times in one week; The serum parathyroid hormone (PTH) level and clinical manifestation were observed before and after one week treatments. Results  The serum parathyroid hormone (PTH) level was reduced significantly in the hemoperfusion and hemodialysis group; compared with hemodialysis，the hemoperfusion and hemodialysis had better effect in PTH clearance（P＜0.05)，meanwhile，some clinical manifestation(appetite，pruritus，inscmnia) improved. Conclusions  3 times hemoperfusion and hemodialysis in one week can effectively clear PTH and improve clinical manifestation.

　　【Key words】Hemoperfusion  Hemodialysis  Uremia  Secondary hyperparathyroidism  

　　随着血液透析疗法的普及和医疗条件的不断改善，尿毒症患者寿命逐渐得到延长，尿毒症继发性甲状旁腺功能亢进症也就比较常见，其相关的代谢紊乱不仅引起肾性骨病，还会导致软组织及血管等钙化，增加心血管疾病的发病率及病死率。继发性甲状旁腺功能亢进症已成为影响尿毒症维持性血液透析患者生活质量和生存率的重要因素。作者采用血液灌流加血液透析对尿毒症继发性甲状旁腺功能亢进症患者行1周3次冲击式治疗，取得较好疗效，现报告如下。

　　1  临床资料

　　1.1 一般资料

　　2007年11月至2008年11月，本院收治尿毒症维持性血液透析患者46例，其中男25例，女21例，年龄（43.2±3.1）岁。原发病：慢性肾小球肾炎28例，糖尿病肾病6例，高血压肾病10例，多囊肾2例。38例有皮肤瘙痒，23例关节肌肉痛。已透析（50.1±3.0）个月，透析方法：予以4周饮食控制及血透活性维生素D3治疗，透析时间为每周3次，每次4h。随机将此46例患者

[1] [2] [3] 下一页