碳酸钙和碳酸镧对维持性血液透析患者内皮功能和FGF23的影响  

Fects of Lanthanum Carbonate and Calcium Carbonate on FGF23 Levels and Vascular Function in Patients Maintaining Hemodialysis

作　　者：傅海霞[1,2] 刘丽秋[1] 李绍莉[2] 

机构地区：[1]青岛大学附属医院肾内科,青岛266000 [2]青岛大学医学院附属市立医院东院肾内科,青岛266071

出　　处：《中国中西医结合肾病杂志》2015年第7期593-595,共3页Chinese Journal of Integrated Traditional and Western Nephrology

摘　　要：目的:比较碳酸钙和碳酸镧对维持性血液透析患者内皮功能和成纤维细胞生长因子23(FGF23)的影响。方法:选取47例维持性血液透析患者口服碳酸镧治疗,同时选取53例维持性血液透析患者口服碳酸钙治疗,作为对照组,观察8周,测量治疗前后的磷、钙、i PTH、血红蛋白、低密度脂蛋白-总胆固醇、白蛋白、25羟维生素D、FGF23及内皮细胞依赖性舒张功能(flow-mediated dilation,FMD),对结果进行分析。结果:治疗前,FMD与血磷(r=-0.32,P=0.002)、FGF23(r=-0.57,P<0.001)呈显著负相关。治疗后,碳酸镧组的FGF23水平下降比碳酸钙组更显著(-27.1%vs-3.8%,P<0.05)。碳酸镧组的FMD显著升高(从6.0%到7.1%),碳酸钙组没有变化(6.1%),P<0.001。用多变量回归分析显示,碳酸镧组FGF23与FMD呈独立的显著相关性,血磷与FMD没有相关性。结论:在维持性血液透析患者,碳酸镧可通过降低FGF23的水平而不是血磷的下降来改善患者的内皮功能。Objective： To compare the effects and to research the mechanism of lanthanum carbonate and calcium carbonate on vascular function and FGF23 on patients maintaining hemodialysis. Methods： Forty - seven patients with hemodialysis received lanthanum carbonate treatment, while fifty - three patients with hemodialysis received calcium carbonate treatment. All patients were observed for 8 weeks. The measurements of serum FGF23 and FMD, and other clinical biochemical indices were performed for all pa- tients before and after treatment. Results： Before treatment, FMD was associated inversely with FGF23 and serum phosphate. After treatment, FMD was associated inversely with serum phosphate （r =-0. 32; P =0. 002） and with FGF23 （r = -0. 57; P 〈0. 001 ）. The serum level of FGF23 was lower in lanthanum - carbonate patients than in calcium - carbonate group（ - 27.1% vs - 3.8% , P 〈 0. 05 ）. The FMD increased from 6.0% to 7.1% in lanthanum - carbonate patients, whereas it was unchanged in the calcium - ear- bonate group（6.1% vs 6.1% ）. On multiple regression analysis, FGF23 in lanthanum- carbonate patients, not serum phosphate, maintained a strong and independent association with FMD. Conclusion：In patients maintaining hemodialysis, independently of serum phosphate level, FGF23 level changes induced by lanthanum carbonate are associated with changes in FMD.

关 键 词：碳酸镧 血液透析 成纤维细胞生长因子23 内皮细胞依赖性舒张功能 血磷 

分 类 号：R692.5[医药卫生—泌尿科学]