低钙透析对血液透析患者钙磷代谢紊乱和冠状动脉钙化的影响  

The Effect of Low-calcium Dialysate on Calcium-phosphorus Metabolism Turbulence and Coronary Artery Calcification in Hemodialysis Patients

作　　者：胡军建[1] 任月运[1] 杨靖[1] 徐建华[1] 

机构地区：[1]江苏省徐州市肿瘤医院肾内科,江苏徐州221005

出　　处：《透析与人工器官》2011年第2期1-4,共4页Chinese Journal of Dialysis and Artificial Organs

摘　　要：目的观察低钙透析液配合口服碳酸钙及阿法骨化醇胶丸对维持性血液透析患者钙磷代谢紊乱和冠状动脉钙化的影响。方法将40例伴有冠状动脉血管钙化行维持性血液透析的患者随机分为两组:A组继续使用标准钙透析液(钙1.75 mmol/L),B组改用低钙透析液(钙1.25 mmol/L);两组均根据血钙调整碳酸钙及阿法骨化醇胶丸的口服剂量。在改用低钙透析液6、12个月时,采用128层螺旋CT检查冠状动脉钙化积分;同时检测血清钙、磷、血清甲状旁腺素。结果采用低钙透析液后6个月时,B组冠状动脉钙化积分轻度下降,P>0.05无统计学差异;12个月时明显下降P<0.05有显著临床差异,A组轻度增高,两组对比P<0.05有显著性临床差异。血磷B组明显下降,A组无明显下降,血iPTH B组明显增加,A组增加不明显,两组对照P<0.05有显著性临床差异。B组碳酸钙的平均口服剂量由(2.06±0.37)g/d增至(3.14±0.23)g/d,阿法骨化醇胶丸的口服剂量由(0.23±0.08)ug/d增至(0.36±0.13)ug/d,A组患者碳酸钙及阿法骨化醇胶丸的的平均口服剂量均无明显变化,两组对照P<0.05,有显著性临床差异。患者均未发生低钙抽搐、低血压等症状。结论低钙透析和含钙的磷结合剂治疗12个月能有效地纠正血液透析患者钙磷代谢紊乱,降低血磷,并且能控制冠状动脉钙化的进展,使甲状旁腺激素升高,但尚在KDIGO临床指南要求范围之内。Objective To study the effect of low-calcium dialysate combined with calcium carbonate and the active form of vitamin D on calcium-phosphorus metabolism turbulence and coronary artery calcification in hemodialysis patients. Methods 40 hemodialysis patients with coronary artery calcification were randomly divided into two groups： Group A （ standard calcium dialysate, calcium 1.75 mmol/L） and Group B （low calcium dialysate, calcium 1.25 mmol/L）. The close of calcium cabonate and 1,25-（OH）2 vitiamin D3 in two groups were depended on blood calcium level. When being dialyzed for 6 and 12 months, all the patients were examined the coronary artery calcification score by 128 arrange spiral CT and serum calcium and phosphorus, parathyroid hormone. Results The coronary artery calcification score was decreased in group B at 6 months, but difference was not significant （P〉0O.05）. The coronary artery calcification score decline was siginificant at 12 months in group B （P〈0.05） and in group A was light rise （P〉0.05）, both groups had significant difference （P〈0.05）. Blood iPTH increased siginificantly in group B （P〈0.05） and in group A was slight （P〉0.05）, the difference between two groups had significant difference （P〈0.05）. Meanwhile, the dose of calcium carbonate was increased from （2.06 ± 0.37） g/d to （3.14 ± 0.23） g/d in group B and 1.25-（OH）2 vitamin D3 was increased from （0.23 ± 0.08） ug/d to （0.36 ± 0.13） ug/d, the dose of calcium carbonate and 1.25-（OH）2 vitamin D3 in group A hadn＇t significant change, difference between two groups was significent（P〈0.05 ）. All patients hasn＇t occured low-calcium spasm and hypotension. Conclusion The low-calcium dialysate and phosphate binder on calcium can ameliorate the calcium-phosphorus metabolism turbulence, decline calcium-phosphorus product, control the progression of coronary artery calcification and inhibition parathyroid horuaone increase was effective.

关 键 词：血液透析 低钙透析 钙磷代谢 冠状动脉钙化积分 甲状旁腺激素 

分 类 号：R459.5[医药卫生—治疗学]