骨形态发生蛋白联合甲状旁腺素评估血液透析联合血液灌流对血液透析肾性骨病患者疗效的效能

doi:10.3760/cma.j.issn.1007-1245.2023.11.009

摘要/Abstract

摘要：

目的　分析骨形态发生蛋白（BMP）、甲状旁腺激素（PTH）评估血液透析联合血液灌流对血液透析肾性骨病患者疗效的效能。方法　回顾性选取2019年1月至2021年6月烟台市莱阳中心医院收治的120例血液透析肾性骨病患者为研究对象，其中男63例，女57例，年龄20.52～78.96岁，经血液透析联合血液灌流治疗，收集患者BMP、PTH等临床资料，随访1年。统计随访期间血液透析联合血液灌流对血液透析肾性骨病患者疗效情况，分析血液透析联合血液灌流治疗后血液透析肾性骨病患者疗效的影响因素，分析BMP与PTH评估血液透析联合血液灌流治疗后血液透析肾性骨病患者无效的价值。采用独立样本t检验、χ²检验、多因素logistic回归分析。结果　120例行血液透析联合血液灌流治疗后血液透析肾性骨病患者，有20例（16.67%）无效，其余100例（83.33%）有效。无效组与有效组性别、年龄、高血压、高血脂、糖尿病、吸烟、饮酒、收缩压、白蛋白对比，差异均无统计学意义（均P>0.05）；无效组BMP、PTH高于有效组（t=3.538、19.018，均P<0.001）。多因素分析显示BMP、PTH水平是血液透析联合血液灌流治疗后血液透析肾性骨病患者疗效的影响因素（OR=2.849，P=0.032；OR=2.770，P<0.001）。受试者工作特征曲线（ROC）分析结果显示，BMP、PTH及二者联合评估血液透析联合血液灌流治疗后血液透析肾性骨病患者无效的灵敏度分别为73.91%、73.91%、86.95%，曲线下面积（AUC）分别为0.763、0.758、0.860；BMP联合PTH的灵敏度高于BMP、PTH单一评估（均P<0.001）。结论　BMP、PTH水平与血液透析联合血液灌流治疗后血液透析患者并发肾性骨病有关，BMP处于高水平时肾性骨病发生风险更高，二者联合评估血液透析联合血液灌流治疗后血液透析患者并发肾性骨病效能较高。

关键词:

血液透析, 血液灌流, 肾性骨病, 骨形态发生蛋白, 甲状旁腺激素, 高血脂, 糖尿病

Abstract:

Objective　To analyze the efficacy of bone morphogenetic protein (BMP) combined with parathyroid hormone (PTH) in the evaluation of effect of hemodialysis combined with hemoperfusion on patients with renal osteodystrophy after hemodialysis. Methods　A total of 120 patients with renal osteodystrophy after hemodialysis admitted to Yantai Laiyang Central Hospital from January 2019 to June 2021 were retrospectively selected as the study objects, including 63 males and 57 females, aged 20.52-78.96 years. After hemodialysis combined with hemoperfusion, clinical data such as BMP and PTH were collected and followed up for 1 year. The curative effect of hemodialysis combined with hemoperfusion on patients with renal osteodystrophy after hemodialysis during the follow-up period were recorded. The factors that affected the curative effect of patients with renal osteodystrophy after hemodialysis after hemodialysis combined with hemoperfusion treatment were analyzed. The values of BMP and PTH in evaluating the ineffectiveness of patients with renal osteodystrophy after hemodialysis after hemodialysis combined with hemoperfusion treatment were analyzed. Independent sample t test, χ² test, and multiple logistic regression analysis were used. Results　Among the 120 patients with renal osteodystrophy after hemodialysis, 20 patients (16.67%) were ineffective after hemodialysis combined with hemoperfusion treatment, and the remaining 100 patients (83.33%) were effective. There were no statistically significant differences in the gender, age, hypertension, hyperlipidemia, diabetes, smoking, drinking, systolic blood pressure, and albumin between the ineffective and effective groups (all P>0.05). The levels of BMP and PTH in the ineffective group were higher than those in the effective group (t=3.538 and 19.018, both P<0.001). Multifactor analysis showed that BMP and PTH were the factors affecting the efficacy of patients with renal osteodystrophy after hemodialysis after hemodialysis combined with hemoperfusion treatment (OR=2.849, P=0.032; OR=2.770, P<0.001). The receiver operating characteristic curve (ROC) analysis results showed that the sensitivities of BMP, PTH, and their combination were 73.91%, 73.91%, and 86.95%, respectively, and the areas under the curves (AUCs) were 0.763, 0.758, and 0.860, respectively; the sensitivity of BMP combined with PTH was higher than those of BMP and PTH alone (both P<0.001). Conclusions　The levels of BMP and PTH are related to renal osteodystrophy in hemodialysis patients after hemodialysis combined with hemoperfusion treatment, and the risk of renal osteodystrophy is higher when BMP is at a high level. BMP combined with PTH to evaluate the efficacy of hemodialysis combined with hemoperfusion in patients with renal osteodystrophy after hemodialysis has a high efficacy.

Key words:

Hemodialysis, Hemoperfusion, Renal osteodystrophy, Bone morphogenetic protein, Parathyroid hormone, Hyperlipemia, Diabetes

叶晓燕于金兰宋新霞杨玲李俊娟.

骨形态发生蛋白联合甲状旁腺素评估血液透析联合血液灌流对血液透析肾性骨病患者疗效的效能 [J]. 国际医药卫生导报, 2023, 29(11): 1518-1522.

Ye Xiaoyan, Yu Jinlan, Song Xinxia, Yang Ling, Li Junjuan.

Efficacy of bone morphogenetic protein combined with parathyroid hormone in the evaluation of effect of hemodialysis combined with hemoperfusion on patients with renal osteodystrophy after hemodialysis [J]. International Medicine and Health Guidance News, 2023, 29(11): 1518-1522.

参考文献

[1] Zavacka M, Zelko A, Madarasova Geckova A, et al. Vascular access as a survival factor for the hemodialysis population: a retrospective study[J]. Int Angiol, 2020, 39(6):525-531. DOI: 10.23736/S0392-9590.20.04401-6.
[2] Ali M, Ejaz A, Iram H, et al. Frequency of intradialytic complications in patients of end-stage renal disease on maintenance hemodialysis[J]. Cureus, 2021, 13(1):e12641. DOI: 10.7759/cureus.12641.
[3] 吴敏华.肾痿方对脾肾气虚、浊毒内阻型维持性血液透析患者肾性骨病的临床研究[D]. 南宁:广西中医药大学,2022.
[4] Galassi A, Ciceri P, Porata G, et al. Current treatment options for secondary hyperparathyroidism in patients with stage 3 to 4 chronic kidney disease and vitamin D deficiency[J]. Expert Opin Drug Saf, 2021, 20(11):1333-1349. DOI: 10.1080/14740338.2021.1931117.
[5] 冯小青.血液透析联合血液灌流对慢性肾功能衰竭患者血清炎症递质及β2-MG、PTH水平的影响[J].中国实用医刊,2021,48(13):57-60. DOI:10.3760/cma.j.cn115689- 20210123-00375.
[6] Tang QH, Yang H, Chen J, et al. Comparison between transposed arteriovenous fistulas and arteriovenous graft for the hemodialysis patients: a meta-analysis and systematic review[J]. J Vasc Access, 2022:11297298221102875. DOI: 10.1177/11297298221102875.
[7] 中国中西医结合学会肾脏疾病专业委员会.慢性肾衰竭中西医结合诊疗指南[J].河北中医,2016,38(2):313-317. DOI:10.3969/j.issn.1002-2619.2016.02.049.
[8] Graves JM, Vallejo JA, Hamill CS, et al. Fibroblast growth factor 23 (FGF23) induces ventricular arrhythmias and prolongs QTc interval in mice in an FGF receptor 4-dependent manner[J]. Am J Physiol Heart Circ Physiol, 2021, 320(6):H2283-H2294. DOI: 10.1152/ajpheart. 00798.2020.
[9] Zheng S, Wang C, Yan H, et al. Fibroblast growth factor-23 as a biomarker of adverse outcomes in patients with coronary artery disease: a meta-analysis[J]. Biomarkers, 2022, 27(4):299-305. DOI: 10.1080/1354750X.2022.2046857.
[10] Guerri G, Bressan S, Sartori M, et al. Hypothyroidism and hyperthyroidism[J]. Acta Biomed, 2019, 90(10-S):83-86. DOI: 10.23750/abm.v90i10-S.8765.
[11] Hanson MA, Shaha AR, Wu JX. Surgical approach to the substernal goiter[J]. Best Pract Res Clin Endocrinol Metab, 2019, 33(4):101312. DOI: 10.1016/j.beem.2019. 101312.
[12] Bel Lassen P, Kyrilli A, Lytrivi M, et al. Graves' disease, multinodular goiter and subclinical hyperthyroidism[J]. Ann Endocrinol (Paris), 2019, 80(4):240-249. DOI: 10.1016/j.ando.2018.09.004.
[13] Mariani G, Tonacchera M, Grosso M, et al. The role of nuclear medicine in the clinical management of benign thyroid disorders, part 1: hyperthyroidism[J]. J Nucl Med, 2021, 62(3):304-312. DOI: 10.2967/jnumed.120.243170.
[14] Jongekkasit I, Jitpratoom P, Sasanakietkul T, et al. Transoral endoscopic thyroidectomy for thyroid cancer[J]. Endocrinol Metab Clin North Am, 2019, 48(1):165-180. DOI: 10.1016/j.ecl.2018.11.009.
[15] Garstka ME, Alameer ES, Awwad SA, et al. Conventional robotic endoscopic thyroidectomy for thyroid cancer[J]. Endocrinol Metab Clin North Am, 2019, 48(1):153-163. DOI: 10.1016/j.ecl.2018.10.005.
[16] Mercader Cidoncha E, Amunategui Prats I, Escat Cortés JL, et al. Scarless neck thyroidectomy using bilateral axillo-breast approach: Initial impressions after introduction in a specialized unit and a review of the literature[J]. Cir Esp (Engl Ed), 2019, 97(2):81-88. DOI: 10.1016/j.ciresp.2018.11.006.
[17] Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism[J]. Br J Surg, 1996, 83(6):875. DOI: 10.1002/bjs.1800830656.
[18] Jawale CV, Li DD, Ramani K, et al. Uremia coupled with mucosal damage predisposes mice with kidney disease to systemic infection by commensal Candida albicans[J]. Immunohorizons, 2021, 5(1):16-24. DOI: 10.4049/immunohorizons.2000114.
[19] Stel VS, de Jong RW, Kramer A, et al. Supplemented ERA-EDTA Registry data evaluated the frequency of dialysis, kidney transplantation, and comprehensive conservative management for patients with kidney failure in Europe[J]. Kidney Int, 2021, 100(1):182-195. DOI: 10.1016/j.kint.2020.12.010.
[20] Pergola PE, Rosenbaum DP, Yang Y, et al. A randomized trial of tenapanor and phosphate binders as a dual-mechanism treatment for hyperphosphatemia in patients on maintenance dialysis (AMPLIFY) [J]. J Am Soc Nephrol, 2021, 32(6):1465-1473. DOI: 10.1681/ASN.2020101398.
[21] Ruggenenti P, Podestà MA, Trillini M, et al. Ramipril and cardiovascular outcomes in patients on maintenance hemodialysis: the ARCADIA multicenter randomized controlled trial[J]. Clin J Am Soc Nephrol, 2021, 16(4):575-587. DOI: 10.2215/CJN.12940820.
[22] Chi XG, Ma Z, Zhang WB, et al. Effects of high-flux hemodialysis combined with levocarnitine on vascular calcification, microinflammation, hepcidin, and malnutrition of elderly patients on maintenance hemodialysis[J]. Ann Palliat Med, 2021, 10(3):3286-3298. DOI: 10.21037/apm-21-66.
[23] Chen HW, Hsieh CB, Hsieh TY, et al. Tacrolimus concentrations were not affected by glecaprevir/pibrentasvir treatment for hepatitis C virus infection in an adult living donor liver transplant recipient with uremia[J]. J Formos Med Assoc, 2021, 120(6):1408-1409. DOI: 10.1016/j.jfma.2020.11.008.
[24] Vernooij RWM, Bots ML, Strippoli GFM, et al. CONVINCE in the context of existing evidence on haemodiafiltration[J]. Nephrol Dial Transplant, 2022, 37(6):1006-1013. DOI: 10.1093/ndt/gfac019.
[25] Yu ML, Kao JH. Reply to "Tacrolimus concentrations were not affected by glecaprevir/pibrentasvir treatment for hepatitis C virus infection in an adult living donor liver transplant recipient with uremia"[J]. J Formos Med Assoc, 2021, 120(6):1410-1411. DOI: 10.1016/j.jfma.2020. 12.023.
[26] Li Q, Zhang S, Wu QJ, et al. Serum total indoxyl sulfate levels and all-cause and cardiovascular mortality in maintenance hemodialysis patients: a prospective cohort study[J]. BMC Nephrol, 2022, 23(1):231. DOI: 10.1186/s12882-022-02862-z.
[27] Sabry R, Tharwat S, Nassar MK, et al. Correction: Ultrasonographic assessment of entheseal sites of upper and lower extremities in hemodialysis patients using Madrid Sonography Enthesitis Index[J]. BMC Musculoskelet Disord, 2022, 23(1):748. DOI: 10.1186/s12891-022-05655-5.
[28] Peralta R, Wammi A, Stauss-Gabo M, et al. A randomised control trial protocol of MuST for vascular access cannulation in hemodialysis patients (MuST Study): contributions for a safe nursing intervention[J]. BMC Nephrol, 2022, 23(1):218. DOI: 10.1186/s12882-022- 02842-3.