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目的:观察分析血液透析联合血液灌流改善慢性肾衰患者钙磷代谢紊乱的疗效及IL-6、hs-CRP、TNF-α水平变化。方法:将104例慢性肾衰患者采用随机数表法分为血液透析组(HD组52例)与血液透析联合血液灌流组(HD+HP组52例),分别给予血液透析与血液透析联合血液灌流治疗。测定2组患者治疗6个月前、后血钙、血磷、钙磷乘积、iPTH水平、炎症因子水平(IL-6、hs-CRP、TNF-α)、BUN、Scr及ALB水平,并进行统计学分析。结果:治疗前2组患者血钙、血磷、钙磷乘积、iPTH水平、IL-6、hs-CRP、TNF-α水平、BUN、Scr、ALB水平比较差异均无统计学意义(P>0.05)。连续治疗6个月后,2组患者血钙无明显变化(P>0.05),血磷、钙磷乘积及iPTH水平明显降低,且HD+HP组明显低于HD组,差异有统计学意义(P<0.05)。连续治疗6个月,HD组患者炎症因子变化不明显,HD+HP组患者的IL-6、hs-CRP、TNF-α水平明显降低,且低于HD组,差异有统计学意义(P<0.05)。治疗6个月后,2组患者BUN、Scr水平明显降低,ALB水平明显升高,且HD+HP组患者BUN、Scr、ALB水平明显优于HD组,差异有统计学意义(P<0.05)。结论:血液透析联合血液灌流可明显改善慢性肾衰患者钙磷代谢紊乱,缓解炎症情况,有效控制肾功能、改善营养状况、有利于患者预后。
OBJECTIVE: To observe the effect of hemodialysis combined with hemoperfusion on the improvement of calcium and phosphorus metabolism disorders and the changes of IL-6, hs-CRP and TNF-α in patients with chronic renal failure. Methods: One hundred and four patients with chronic renal failure were divided into hemodialysis group (HD group, 52 cases) and hemodialysis combined hemoperfusion group (HD + HP group, 52 cases), respectively. Hemodialysis and hemodialysis combined with blood Perfusion therapy. The levels of serum calcium, phosphorus, calcium and phosphorus, iPTH, levels of inflammatory cytokines (IL-6, hs-CRP, TNF-α), BUN, Scr and ALB were measured 6 months after treatment. Statistical analysis. Results: The levels of serum calcium, phosphorus, calcium and phosphorus, iPTH, IL-6, hs-CRP, TNF-α, BUN, Scr and ALB in the two groups before treatment were not significantly different ). After 6 months of continuous treatment, there was no significant change in serum calcium between the two groups (P> 0.05). The levels of serum phosphorus, calcium and phosphorus and iPTH were significantly lower than those of HD group (P <0.05), and the difference was statistically significant P <0.05). The levels of IL-6, hs-CRP and TNF-α in HD + HP group were significantly lower than those in HD group after 6 months of continuous treatment, with no significant changes in inflammatory cytokines in HD group (P < 0.05). The levels of BUN, Scr and ALB in HD group were significantly lower than those in HD group (P <0.05) after 6 months of treatment. The levels of BUN, Scr and ALB in HD + HP group were significantly higher than those in HD group . Conclusion: Hemodialysis combined with hemoperfusion can significantly improve the disorder of calcium and phosphorus metabolism in patients with chronic renal failure, relieve the inflammation, effectively control the renal function and improve the nutritional status, which is in favor of the prognosis of the patients.