血液灌流联合血液透析对维持性血液透析所致心脏瓣膜钙化的影响

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摘要目的探讨血液灌流联合血液透析与血液透析滤过两种治疗方法对维持性血液透析心脏瓣膜钙化的影响。方法选取2014年4月～2016年5月在石家庄市第三医院就诊的慢性肾衰竭血液透析有心脏瓣膜钙化的患者60例，将入选者按随机数字表法分为A、B组，每组各30例。A组患者行血液灌流联合血液透析治疗，B组患者行血液透析滤过治疗，两组患者均治疗6个月。比较两组患者治疗前后空腹静脉血胎球蛋白-A（Fetuin-A）、超敏C反应蛋白（hs-CRP）、全段甲状旁腺激素（iPTH）水平，以及血钙、血磷、β2-微球蛋白（β2-MG）等生化指标的改善程度；记录两组患者治疗过程中的不良反应发生情况。结果治疗后，两组Fetuin-A水平均较治疗前明显提高，且A组显著高于B组，差异有统计学意义（P ＜ 0.05）；此外，两组hs-CRP、iPTH、血磷及β2-MG水平均较治疗前显著降低，且A组各指标均明显低于B组，差异有统计学意义（P ＜ 0.05）；治疗后两组血钙水平均较治疗前明显升高，但A组治疗后显著低于B组，差异有统计学意义（P ＜ 0.05）；A组临床不良反应总发生率显著低于B组，差异有统计学意义（P ＜ 0.05）。结论血液灌流联合血液透析治疗对维持性血液透析患者瓣膜钙化的预防与控制效果优于血液透析滤过。

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	宋菊香宋培马辉

关键词 ：心脏瓣膜钙化, 血液透析滤过, 血液灌流, 血液透析, 胎球蛋白A

Abstract：Objective To investigate the effects of the two methods of hemoperfusion combined with hemodialysis and hemodiafiltration for the cardiac valve calcification caused by maintenance hemodialysis. Methods Sixty patients with cardiac valve calcification underwent hemodialysis because of chronic renal failure treated in the Third Hospital of Shijiazhuang City from April 2014 to May 2016 were selected and divided into group A and B by random number table method, with 30 cases in each group. Group A was taken hemoperfusion combined with hemodialysis therapy, group B was taken hemodiafiltration, both groups were treated for 6 months. The levels of fetuin-A, high-sensitivity C-reactive protein (hs-CRP), intact parathyroid hormone (iPTH) of fasting venous blood, and the improvement of blood calcium, serum phosphate, β2-microglobulin (β2-MG) before and after treatment between the two groups were compared, and the occurrence of adverse reactions of the two groups during treatment was recorded. Results After treatment, the levels of fetuin-A in the two groups were all higher than those before treatment, which of group A was higher than that of group B, the differences were all statistically significant (P ＜ 0.05); in addition, the levels of hs-CRP, iPTH, serum phosphorus and β2-MG in the two groups were all significantly lower than those before treatment, and the indexes above in group A were all significantly lower than those of group B, the differences were all statistically significant (P ＜ 0.05); after treatment, the levels of serum calcium in the two groups were all higher than those before treatment, while group A was significantly lower than that of group B, the differences were all statistically significant (P ＜ 0.05). The total incidence of clinical adverse reactions of group A was significantly lower than that of group B, the difference was all statistically significant (P ＜ 0.05). Conclusion The effects of hemoperfusion combined with hemodialysis for preventing and controlling cardiac valve calcification caused by maintenance hemodialysis are better than that of hemodiafiltration.

Key words： Heart valve calcification Hemodiafiltration Hemoperfusion Hemodialysis Fetuin-A

引用本文:

宋菊香宋培马辉. 血液灌流联合血液透析对维持性血液透析所致心脏瓣膜钙化的影响[J]. 中国医药导报, 2017, 14(33): 82-85.
SONG Juxiang SONG Pei MA Hui. Effects of hemoperfusion combined with hemodialysis on cardiac valve calcification caused by maintenance hemodialysis. 中国医药导报, 2017, 14(33): 82-85.

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