| Purpose:To understand the efficacy of hemoperfusion(HP)combined with maintenance hemodialysis(MHD)in secondary hyperparathyroidism(SHPT)that is ineffective in basic therapy and the benefits of itching and malnutrition during treatment.Methods:We collected SHPT patients from May 2017 to September 2018 in Yan'an University affiliated who underwent MHD treatment for more than 3months.According to the calcium and phosphorus levels,all patients were divided into three groups:the first group of calcium and phosphorus were normal,and these patients were given bone triol shock treatment for 6 months,the effective treatment was maintained,and the invalid patients entered the experimental group;The second group high-phosphorus,low-calcium and Ca×P<4.52mmol~2/L~2,first given this patient calcium carbonate phosphorus reduction treatment for 3 months,when the blood phosphorus is less than 1.45mmol/L,then re-calculated with calcitriol,if it is still greater than or equal to 1.45mmol/L,enter the experimental group;The third group high calcium with or without high phosphorus or Ca×P?4.52mmol~2/L~2,directly into the experimental group.The experimental group treatment was MHD combined with HP treatment.Ionic calcium(Ca),blood phosphorus(P),calcium-phosphorus product(Ca x P),intact parathyroid hormone(iPTH),?2 microglobulin(?2-MG),visual analogue scale(VAS)itch score,improved double itch score,hemoglobin(Hb),albumin(ALB),prealbumin(PA)were collected pre-treatment and every 3 months after treatment.SPSS22.0 statistical software was used for data processing to compare the therapeutic effects of patients.Result:1.A total of 108 SHPT patients were collected in this study,including 71 males(66%)and 37 females(34%).The average age was 46.85±13.23 years,and the average dialysis age was 45.5(28.75,68.00)months.There were 40 cases in group 1,36 cases in group 2 and 32 cases in group 3.In the experimental group,53 patients were observed.The distribution of the three groups was as follows:9 cases(16.4%)in the first group,14cases(25.5%)in the second group,30 cases(58.1%)in the third group.The effective rate of HP for SHPT which was ineffective in basic treatment was about 77.36%.2.The curative effect of HP on SHPT patients who had ineffect on basic treatment showed that the levels of iPTH,Ca,P and Ca×P of patients after HP were lower than those before(P<0.01).3.The itching degree of SHPT patients was significantly alleviated after HP(P<0.01),and the toxins P,?2-MG and iPTH related to itching were all decreased(P<0.01).4.After HP,the nutritional status of SHPT patients was improved,and the levels of Hb and ALB were increased(P<0.05).Conclusion:1.HP may be effective in patients with SHPT who are ineffective in basic treatment.2.HP may have a certain effect on the removal of Ca,P,Ca×P and iPTH in SHPT patients who are ineffective in basic treatment.3.HP may play a role in skin pruritus and malnutrition caused by SHPT. |
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