血液透析患者应用低钙透析液的临床研究  

Clinical research of low-calcium dialysate in hemodialysis

作　　者：郭齐[1] 张虹[1] 孙晶[1] 王雪梅[1] 王钰君[1] 潘虹[1] 王荣[1] 王群[1] 

机构地区：[1]山东大学附属省立医院肾内科,山东济南250012

出　　处：《中国医药导报》2011年第33期54-56,共3页China Medical Herald

摘　　要：目的:探讨维持性血液透析患者如何应用低钙透析液。方法:将43例试验前长期应用1.25 mmol/L低钙透析液的维持性血液透析患者随机分入试验组(T组)(20例)和对照组(C组)(23例)。根据入组时血全段甲状旁腺激素(intact parathyroid hormone,iPTH)水平<500 ng/L或≥500 ng/L,T组和C组又分别分为T1组(9例)、T2组(11例)和C1组(15例)、C2组(8例)。入组后T组改用1.50 mmol/L钙浓度血液透析液,C组继续应用1.25 mmol/L钙浓度血液透析液。分别在入组时和入组6个月后检测T组和C组透析前血iPTH水平、血钙及血磷水平,计算钙磷乘积,并进行入组前后和组间的比较。结果:T1组的血iPTH水平有下降的趋势,但与入组前比较差异无统计学意义(P>0.05);T1组的血钙、血磷及钙磷乘积水平与入组前比较变化均不明显(P>0.05)。T2组的血iPTH水平显著下降(P<0.01),血磷水平也有明显下降(P<0.05);而T2组的血钙和钙磷乘积水平无变化(P>0.05)。C1组和C2组的血iPTH水平、血钙、血磷及钙磷乘积水平与入组前比较差异均无统计学意义(P>0.05)。结论:对于伴中重度继发性甲旁亢(iPTH水平≥500 ng/L)、血钙正常或偏低的血液透析患者,长期应用1.25 mmol/L钙浓度透析液可能加重甲状旁腺功能亢进。这类患者选择1.50 mmol/L钙浓度的血液透析液有利于降低血iPTH水平,还可降低血磷水平,而不会升高血钙水平。Objective： To investigate how to use low calcium dialysate in hemodialysis patients.Methods： 43 maintenance hemodialysis patients who had used 1.25 mmol/L calcium dialysate longer than 6 months were divided into test group（T group） and control group（C group）.According to different iPTH level,T group were divided into T1（iPTH500 ng/L） and T2（iPTH≥500 ng/L） subgroups and C group were divided into C1（iPTH500 ng/L） and C2（iPTH≥500 ng/L） subgroups.Then the patients of T group changed to used 1.50 mmol/L calcium dialysate and the patients of C group continued to use 1.25 mmol/L calcium dialysate for six months.The variety of serum iPTH,Ca,P,Ca×P were compared.Results： Six months later,iPTH of T1 subgroup decreased slightly,but there were no significant difference（P0.05）.There were no significant variety of iPTH,Ca,P and Ca×P for T1 subgroup（P0.05）.iPTH and P of T2 subgroup decreased significant（P0.01,P0.05）,but there were no significant variety of Ca and Ca×P for T2 subgroup（P0.05）.For C1 and C2 subgroups,there were no significant variety of iPTH,P,Ca and Ca×P（P0.05）.Conclusion： Long-term using 1.25 mmol/L calcium dialysate may increase PTH secretion of hemodialysis patients with moderate or serious secondary hyperparathyroidism.For those hemodialysis patients,using 1.50 mmol/L calcium dialysate may decrease serum iPTH and phosphate level,yet may not increase serum calcium level.

关 键 词：血液透析 低钙透析液 钙浓度 

分 类 号：R457[医药卫生—治疗学]