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目的探讨规律性血液透析联合骨化三醇治疗慢性肾功能衰竭(肾衰)患者高转运骨营养不良的效果。方法选取2013年3月—2015年3月本院收治的慢性肾衰患者高转运骨营养不良110例患者,随机分为对照组54例和观察组56例,对照组予以规律性血液透析联合大剂量骨化三醇治疗,观察组予以规律性血液透析联合小剂量骨化三醇治疗,透析血液的流速设置为250 ml/min,透析液流速设置为500 ml/min。维持性血液透析置换量为患者体质量的30%,血液透析的频率为3次/周,对照组患者每次透析后均予以骨化三醇1.0μg口服,观察组患者每次透析后均予以骨化三醇0.5μg口服,治疗周期为16周,比较两组患者的治疗效果。计量资料采用t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果观察组及对照组患者治疗前后的ALB、BUN、Scr及肾性骨营养不良(renal osteodystrophy,ROD)症评分对比差异均无统计学意义(均P>0.05),观察组与对照组治疗后ROD评分均优于治疗前[(1.55±0.35)、(1.55±0.38)、(4.66±1.98)、(4.74±2.17)分],对比差异均有统计学意义(均P<0.05)。治疗后,对照组与观察组患者的血清i PTH、磷水平、钙磷乘积均明显优于治疗前[(41.16±6.27)、(21.57±8.64)、(89.23±14.56)、(88.45±15.03)pmol/L、(2.22±0.28)、(1.76±0.38)、(2.47±0.32)、(2.56±0.27)、(51.17±7.36)、(47.23±11.41)、(55.93±5.92)、(55.22±4.80)mg2/dl2],对比差异均有统计学意义(均P<0.05);且观察组的血清i PTH、磷水平、钙磷乘积均明显优于对照组[(21.57±8.64)、(41.16±6.27)pmol/L、(1.76±0.38)、(2.22±0.28)mmol/L、(47.23±11.41)、(51.17±7.36)mg2/dl2],对比差异均有统计学意义(均P<0.05)。结论规律性血液透析联合大剂量及小剂量骨化三醇治疗慢性肾衰患者高转运骨营养不良的疗效相当,但规律性血液透析联合小剂量骨化三醇治疗能有效减少不良反应的发生。
Objective To investigate the effect of regular hemodialysis combined with calcitriol on dystrophy with high translocation in patients with chronic renal failure (renal failure). Methods A total of 110 patients with chronic renal failure who were admitted to our hospital from March 2013 to March 2015 were randomly divided into control group (n = 54) and observation group (n = 56). The control group was treated with regular hemodialysis The patients in the observation group received regular hemodialysis combined with low-dose calcitriol. The dialysis blood flow rate was set at 250 ml / min and the dialysate flow rate at 500 ml / min. The maintenance hemodialysis replacement volume was 30% of the patient’s body weight and the frequency of hemodialysis was 3 times / week. The patients in the control group were given 1.0 μg of calcitriol orally after each dialysis. The patients in the observation group were given each dialysis Calcitriol 0.5μg orally, the treatment period of 16 weeks, the treatment effect of two groups were compared. Measurement data using t test, count data using χ2 test, P <0.05 for the difference was statistically significant. Results The scores of ALB, BUN, Scr and renal osteodystrophy (ROD) before and after treatment in the observation group and the control group were not significantly different (all P> 0.05). The difference between the observation group and the control group after treatment ROD scores were significantly higher than those before treatment [(1.55 ± 0.35), (1.55 ± 0.38), (4.66 ± 1.98), (4.74 ± 2.17), respectively. The differences were statistically significant (all P <0.05). After treatment, the serum i PTH, phosphorus levels and calcium and phosphorus products of the control group and the observation group were significantly better than those before treatment [(41.16 ± 6.27), (21.57 ± 8.64), (89.23 ± 14.56), (88.45 ± 15.03) (2.22 ± 0.28), (2.47 ± 0.32), (2.56 ± 0.27), (51.17 ± 7.36), (47.23 ± 11.41), (55.93 ± 5.92), (55.22 ± 4.80 (mg / dl2), the differences were statistically significant (all P <0.05); and the serum i PTH, phosphorus levels and calcium and phosphorus in the observation group were significantly better than those in the control group [(21.57 ± 8.64), (41.16 ± (P <0.05). There was significant difference between the two groups (P <0.05) and the difference was statistically significant (P <0.05) . Conclusion Regular hemodialysis combined with high-dose and low-dose calcitriol treatment of chronic renal failure in patients with high translocation of bone dystrophy efficacy, but regular hemodialysis combined with low-dose calcitriol treatment can effectively reduce the incidence of adverse reactions.