血液透析联合血液灌流治疗维持性透析患者矿物质和骨代谢异常的临床研究

Clinical Study of Hemodialysis Combined with Hemoperfusion in the Treatment of Mineral and Bone Metabolic Disorders in Maintenance Dialysis Patients

摘要: 目的：探究血液透析联合血液灌流治疗维持性透析患者矿物质和骨代谢异常的效果。方法：选取我中心60名维持性血液透析治疗的患者，以1:2的比例随机分成治疗组和对照组，治疗组在常规血液透析的基础上，再予每个月1次HP，对照组接受常规血液透析治疗，对比分析两组治疗效果。结果：治疗组和对照组患者的基线数据未有统计学差异。治疗组治疗后(3.1 ± 1.2)与治疗前(4.7 ± 2.7)的瘙痒指数水平有统计学差异(P = 0.022)，对照组治疗后与治疗前的瘙痒指数无统计学差异(P = 0.956)，治疗组与对照组瘙痒指数治疗前后的差值有统计学差异(P = 0.002)。治疗组与对照组血钙水平治疗前后差值有统计学差异(P = 0.002)。重复测量方差分析结果显示，治疗组(血液透析联合血液灌流)是瘙痒指数和血磷水平的影响因素(分别F = 4.219，P = 0.045，F = 8.615，P = 0.005)。结论：血液透析联合血液灌流可改善维持性血液透析患者矿物质与钙代谢异常，提高治疗疗效，改善血磷水平，控制瘙痒症状，有良好的应用前景。

Abstract: Objective: To investigate the efficacy of combined hemodialysis and hemoperfusion (HP) therapy in maintaining mineral and bone metabolism disorders in patients undergoing maintenance dialysis. Methods: Sixty patients receiving maintenance hemodialysis were randomly assigned in a 1:2 ratio to a treatment group (receiving HP once monthly in addition to standard hemodialysis) or a control group (standard hemodialysis only). The therapeutic effects were compared between groups. Results: No significant baseline differences were observed between groups. The treatment group showed statistically significant improvement in pruritus index (3.1 ± 1.2 vs. 4.7 ± 2.7, P = 0.022), while the control group showed no significant change (P = 0.956). The difference in pruritus index between groups before and after treatment was statistically significant (P = 0.002). Similarly, blood calcium levels showed statistically significant differences between groups before and after treatment (P = 0.002). The repeated measures ANOVA revealed that the combined hemodialysis and hemoperfusion treatment significantly influenced both the pruritus index and serum phosphorus levels (F = 4.219, P = 0.045; F = 8.615, P = 0.005, respectively). Conclusion: This combined therapy effectively addresses mineral and calcium metabolism disorders in maintenance hemodialysis patients, enhances treatment efficacy, improves phosphorus levels, and alleviates pruritus symptoms, demonstrating promising clinical applications.