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目的探讨不同的血液净化方式对维持性血液透析患者血清甲状旁腺激素的影响,观察皮肤瘙痒、骨关节疼痛、肌无力症状。方法选择蚌埠医学院第一附属医院血液净化中心符合入选标准的维持性血液透析患者60例,随机分为3组:血液透析(HD)治疗组、血液透析滤过(HDF)治疗组、血液透析联合血液灌流(HD+HP)治疗组,每组患者20例。比较3组患者治疗6个月前、后血清甲状旁腺激素水平及血清甲状旁腺激素的清除率,观察并记录皮肤瘙痒、骨关节疼痛、肌无力症状改善情况。结果 3组血清甲状旁腺激素水平较治疗前均有下降,HD组治疗后血清甲状旁腺激素水平下降无统计学意义(P>0.05),HDF组、HD+HP组治疗后血清甲状旁腺激素水平均明显降低(P<0.01)。3组血清甲状旁腺激素清除率比较,HD组为(5.65±3.25)%、HDF组为(40.30±2.70)%、HD+HP组为(41.16±5.30)%,HDF组、HD+HP组均优于HD组(P<0.01),HDF组、HD+HP组之间比较差异无统计学意义(P>0.05)。HDF组、HD+HP组皮肤瘙痒、骨关节疼痛、肌无力症状改善情况均优于HD组(P<0.05)。结论定期进行HDF与HD+HP治疗,可有效清除患者体内血清甲状旁腺激素的蓄积,减少长期透析相关并发症的发生,提高生活质量。
Objective To investigate the effects of different methods of blood purification on serum parathyroid hormone in maintenance hemodialysis patients and to observe the symptoms of pruritus, joint pain and muscle weakness. Methods Sixty patients with maintenance hemodialysis who meet the inclusion criteria were selected from the First Affiliated Hospital of Bengbu Medical College Blood Purification Center and randomly divided into three groups: hemodialysis (HD) group, hemodiafiltration group (HDF), hemodialysis Combined hemoperfusion (HD + HP) treatment group, 20 cases in each group. The serum parathyroid hormone levels and serum parathyroid hormone clearance rate were compared between the three groups before 6 months of treatment. The pruritus, joint pain and muscle weakness symptoms were observed and recorded. Results Serum parathyroid hormone levels decreased in all three groups compared with those before treatment. There was no significant difference in serum parathyroid hormone level between HD group and HDF group (P> 0.05) Hormone levels were significantly lower (P <0.01). The levels of serum parathyroid hormone clearance in the three groups were (5.65 ± 3.25)% in HD group, (40.30 ± 2.70)% in HDF group, (41.16 ± 5.30)% in HD + HP group, (P <0.01). There was no significant difference between HDF group and HD + HP group (P> 0.05). HDF group, HD + HP group pruritus, bone and joint pain, muscle weakness symptoms were better than HD group (P <0.05). Conclusion Regular HDF and HD + HP treatment can effectively remove the accumulation of serum parathyroid hormone in patients, reduce the occurrence of long-term dialysis-related complications and improve the quality of life.