低钙透析液治疗维持性血液透析患者动力缺失性骨病的临床观察  

Clinical observation of low calcium dialysate on adynamic bone disease of the maintained hemodialysis patients

作　　者：李涌泉 张欣洲[1,2] 王康 张万帆[1,2] 黄旋珠 

机构地区：[1]广东省深圳市人民医院 [2]暨南大学第二临床医学院肾内科,广东深圳518020

出　　处：《中国医药导报》2010年第18期54-56,共3页China Medical Herald

摘　　要：目的:观察低钙透析液治疗维持性血液透析患者动力缺失性骨病的有效性和安全性以及对钙磷代谢的影响。方法:选取合并动力缺失性骨病的维持性血液透析患者31例,应用1.25mmol/L钙浓度透析液治疗12个月,观察不同时期(第1、3、6、12个月)患者血iPTH、血钙、血磷、血钙磷乘积、血红蛋白、白蛋白等指标的变化及相关不良反应。结果:所有患者治疗前血清总钙、血磷、钙磷乘积均高于NKF-K/DOQI指南推荐的目标范围,iPTH均<100pg/ml,低钙透析液治疗1个月后患者iPTH水平较治疗前即明显升高,并随着治疗时间的延长,iPTH水平逐渐升高,治疗12个月后达到高峰,iPTH水平达到NKF-K/DOQI指南推荐的目标范围(150～300pg/ml)患者的比例随着治疗时间的延长逐渐上升;同时血清总钙、血磷、钙磷乘积水平在治疗1个月后即较治疗前均明显下降(P<0.05),随着治疗时间的延长下降更明显,治疗6个月后血清总钙、血磷、钙磷乘积逐渐趋于稳定。治疗前后患者血清白蛋白、血红蛋白、促红细胞生成素用量无明显差异,无明显低血压发生,低钙抽搐发生比例与普通钙(1.5mmol/L)透析液患者无明显差异。结论:低钙透析液(1.25mmol/L)能有效地治疗维持性血液透析患者的动力缺失性骨病并且有较好的安全性,同时能较好地控制血钙、血磷、钙磷乘积水平。Objective：To observe the effectiveness and safety of low calcium dialysate in maintained hemodialysis（MHD） patients with adynamic bone disease.Methods：31 cases of maintained hemodialysis patients with adynamic bone disease received treatment of low calcium dialysate（calcium concentration 1.25 mmol/L） for a period of 12 months.Levels of serum iPTH,calcium,phosphorus,calcium-phosphorus product,albumin and hemoglobin were analyzed at 1,3,6,12 months.Results：Levels of serum iPTH,calcium,phosphorus,calcium-phosphorus product in all patients exceeded the range recommended by the guideline of NKF-K/DOQI before the treatment;after treatment with low calcium dialysate 1 month,level of serum iPTH increased significantly,and increased gradually with the treatment time prolonged,and reached a peak at 12 months;at the same time,levels of serum calcium,phosphorus,calcium-phosphorus product decreased gradually from 1 to 6 months compared with before treatment,but changed slightly in the following 6 months.There was no significant change in serum albumin and hemoglobin level and dosage of erythropoietin during treatment.The majority of patients tolerated low calcium dialysate well,no significant hypotension and hyperspasmia appeared during treatment.Conclusion：The low calcium dialysate can effectively and safely treat patients with adynamic bone disease in maintained hemodialysis;meanwhile,it can effectively control level of serum calcium,phosphorus and calcium-phosphorus product.

关 键 词：低钙透析液 动力缺失性骨病 血液透析 甲状旁腺素 

分 类 号：R692.5[医药卫生—泌尿科学]