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目的观察血液灌流联合血液透析对血液透析患者甲状旁腺素(PTH)的清除疗效,分析维持性血液透析(MHD)患者重组人红细胞生成素(rHuEPO)治疗剂量的影响因素。方法将51例皮肤瘙痒和顽固性贫血的尿毒症患者随机分为2组:串联组25例,采用血液灌流联合血液透析治疗;对照组26例,采用常规血液透析治疗。共治疗12周。观察2组治疗前后皮肤瘙痒症状改善情况;治疗前、后测定PTH和红细胞压积(Hct)水平,分析rHuEPO治疗剂量与PTH水平的相关性。结果串联组rHuEPO/Hct和PTH水平明显低于对照组(P均<0.05),PTH清除率高于对照组[(58.8±1.7)%vs(11.2±1.2)%,P<0.05],皮肤瘙痒改善率明显高于对照组(84.00%vs30.77%,P<0.05);rHuEPO/Hct与PTH水平呈正相关(r=0.27,P<0.05)。结论血液灌流联合血液透析能有效地清除血清PTH,改善患者皮肤瘙痒症状,提高rHuEPO的疗效。
Objective To observe the effect of hemoperfusion combined with hemodialysis on parathyroid hormone (PTH) clearance in patients undergoing hemodialysis and the influencing factors of the dose of recombinant human erythropoietin (rHuEPO) in maintenance hemodialysis (MHD) patients. Methods Totally 51 patients with pruritus and refractory anemia were randomly divided into 2 groups: 25 in series group and 24 in control group. The patients in control group were treated with hemodialysis. A total of 12 weeks of treatment. The improvement of skin pruritus before and after treatment was observed in two groups. The levels of PTH and hematocrit were measured before and after treatment. The correlation between the dosage of rHuEPO and the level of PTH was analyzed. Results The levels of rHuEPO / Hct and PTH in the tandem group were significantly lower than those in the control group (all P <0.05), and the clearance rate of PTH was higher than that in the control group [(58.8 ± 1.7)% vs (11.2 ± 1.2)%, P < The improvement rate was significantly higher than that of the control group (84.00% vs 30.77%, P <0.05). There was a positive correlation between rHuEPO / Hct and PTH (r = 0.27, P <0.05). Conclusion Hemoperfusion combined with hemodialysis can effectively remove serum PTH, improve the skin pruritus symptoms and improve the efficacy of rHuEPO.