维持性血液透析患者钙、磷代谢的变化  

Changes of calcium and phosphate metabolism in maintenance hemodialysis patients: survey in a dialysis center

作　　者：李芸[1] 丁峰[1] 顾勇[1] 薛骏[1] 李铭新[1] 施雪枫[1] 陆福明[1] 林善锬[1] 

机构地区：[1]复旦大学附属华山医院肾脏病科,上海200040

出　　处：《上海医学》2004年第8期552-555,共4页Shanghai Medical Journal

摘　　要：目的　回顾性分析近年来维持性血液透析患者钙、磷代谢紊乱的变迁情况 ,并探讨可能的原因。方法　对 1999年和 2 0 0 3年在我院进行维持性血液透析的终末期肾病患者进行回顾性分析 ,比较两组患者钙、磷代谢和一般营养状况、透析充分性等指标以及治疗方法的差异。结果　两组患者在人口构成上的差异无显著性。 2 0 0 3年透析用水以超纯水代替 1999年的单纯反渗水 ,并部分使用超低钙透析液 (1.2 5mmol/L) ;透析膜由复用 5次改为不复用 ;透析时间和频率明显增加 (P <0 .0 1) ;血液透析滤过 (HDF)比例增加 (P <0 .0 1) ;平均促红素和磷螯合剂用量增加 (P <0 .0 5 ) ;使用活性维生素D3 患者比例明显减少 (P <0 .0 5 ) ;铁剂用量变化不明显。与 1999年相比 ,2 0 0 3年患者血磷和钙、磷乘积明显升高 (P <0 .0 1) ;血钙、甲状旁腺激素 (iPTH)无明显变化 ;血红蛋白 (Hb)、血浆白蛋白 (Alb)、透前尿素氮 (BUN)均有提高 (P <0 .0 5 ) ;整体尿素清除率 (Kt/V)、校正蛋白分解率 (nPCR)变化不明显。结论　与 1999年相比 ,2 0 0 3年钙、磷代谢紊乱有所加重 ,可能与促红素用量增加及水质改善后患者红细胞比容上升、有效血浆流量下降导致血磷清除减少有关。提示在改善透析患者一般营养情况的同时 ,更应重视增加透析和药物?Objective To analyze the changes of calcium and phosphate metabolism in maintenance hemodialysis (MHD) patients in a dialysis center.Methods A retrospective study was performed to assess the calcium and phosphate metabolism, nutritional status, adequacy of dialysis (serum calcium, serum phosphate , calcium×phosphate product, iPTH, hemoglobin, albumin, pre-dialysis BUN, nPCR, Kt/V) and the differences of renal replacement therapy in the year 1999 versus those in the year 2003 in MHD patients.Results There was no significant difference in age, gender, time of HD, and underlying renal disease between the two groups. In the year 2003, ultra-pure water instead of reverse osmosis water was used to prepare the dialysate. Some of the patients used dialysate with decreased calcium concentration (1.25 mmol/L). Hemodialyzers were re-used 5 times in 1999 in contrast to that used once only in 2003. Compared to those of the year 1999, patients in 2003 received more frequent hemodialysis (P<0.01), higher ratio of hemodiafiltration (P<0.01), increased average dose of erythropoietin and phosphate chelators (P<0.05), less calcitriol (P<0.05), and comparative average dose of ferrous succinate. Levels of serum phosphate (P<0.01), calcium×phosphate product (P<0.01), hemoglobin (P<0.05), albumin (P<0.05), pre-dialysis BUN (P< 0.05) in the year 2003 were higher than those in 1999, whereas the levels of serum calcium, iPTH and values of Kt/V, nPCR were comparable in the two groups.Conclusion Compared with those of the year 1999, the disordered calcium and phosphate metabolism in 2003 got worser, then, attributing to the decrease of phosphate clearance due to rise of hematocrit and decrease of effective plasma flow. More powerful therapies to increase the clearance of phosphate either by more dialysis or phosphate chelators are urgently called for.

关 键 词：血液透析 血磷 钙磷乘积 红细胞比容 

分 类 号：R459.5[医药卫生—治疗学]