血液灌流聯合血液透析對維持性血液透析所致心臟瓣膜鈣化的影響

宋菊香+宋培+馬輝

[摘要] 目的 探討血液灌流聯合血液透析與血液透析濾過兩種治療方法對維持性血液透析心臟瓣膜鈣化的影響。 方法 選取2014年4月～2016年5月在石家莊市第三醫院就診的慢性腎衰竭血液透析有心臟瓣膜鈣化的患者60例，將入選者按隨機數字表法分為A、B組，每組各30例。A組患者行血液灌流聯合血液透析治療，B組患者行血液透析濾過治療，兩組患者均治療6個月。比較兩組患者治療前后空腹靜脈血胎球蛋白-A（Fetuin-A）、超敏C反應蛋白（hs-CRP）、全段甲狀旁腺激素（iPTH）水平，以及血鈣、血磷、β2-微球蛋白（β2-MG）等生化指標的改善程度；記錄兩組患者治療過程中的不良反應發生情況。 結果 治療后，兩組Fetuin-A水平均較治療前明顯提高，且A組顯著高于B組，差異有統計學意義（P < 0.05）；此外，兩組hs-CRP、iPTH、血磷及β2-MG水平均較治療前顯著降低，且A組各指標均明顯低于B組，差異有統計學意義（P < 0.05）；治療后兩組血鈣水平均較治療前明顯升高，但A組治療后顯著低于B組，差異有統計學意義（P < 0.05）；A組臨床不良反應總發生率顯著低于B組，差異有統計學意義（P < 0.05）。 結論 血液灌流聯合血液透析治療對維持性血液透析患者瓣膜鈣化的預防與控制效果優于血液透析濾過。

[關鍵詞] 心臟瓣膜鈣化；血液透析濾過；血液灌流；血液透析；胎球蛋白A

[中圖分類號] R542.5 [文獻標識碼] A [文章編號] 1673-7210（2017）11（c）-0082-04

Effects of hemoperfusion combined with hemodialysis on cardiac valve calcification caused by maintenance hemodialysis

SONG Juxiang SONG Pei MA Hui

Department of Nephrology， the Third Hospital of Shijiazhuang City， Hebei Province， Shijiazhuang 050000， China

[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.endprint

[Key words] Heart valve calcification； Hemodiafiltration； Hemoperfusion； Hemodialysis； Fetuin-A

目前慢性腎臟?。–KD）已成為我國的常見病及多發病，且患病人數逐年上升。據統計，我國的CKD患者約有1.19億，且CKD患者的血管與瓣膜鈣化的發生率均很高。經CT掃描證實約有2/3維持性血液透析（MHD）患者的冠狀動脈出現了不同程度的鈣化，高達50%的患者出現了心臟瓣膜鈣化[1]。胎球蛋白A（Fetuin-A）是廣泛存在于細胞外液中的與血管鈣化負相關的一種蛋白，Fetuin-A水平降低，預示著患者血管鈣化的發生風險增加[2]。臨床研究表明，低Fetuin-A狀態與MHD患者心血管死亡率和全因死亡率相關[3-4]。MHD患者血磷、血鈣水平受影響較大，高磷血癥的發生率高，血磷控制難度大，且血管、心肌、心臟瓣膜鈣化導致的心血管事件發生率遠遠高于普通人群，可見透析患者的血磷、血鈣水平升高是心血管鈣化的主要危險因素?！?br>