维持性血液透析患者应用活性维生素D的临床效果观察  

Clinical observation of active vitamin D supplement in patients with maintenance hemodialysis

作　　者：李欣[1] 杨洁[1] 丁致民[1] 

机构地区：[1]北京积水潭医院肾内科,100035

出　　处：《中国医药》2017年第3期375-378,共4页China Medicine

摘　　要：目的观察维持性血液透析（MHD）患者应用活性维生素D的临床效果。方法选取2015年3—6月于北京积水潭医院血液净化中心进行MHD且存在25-羟基维生素D3[25-（OH）D3]缺乏的患者42例。基础药物及血液透析治疗的同时给予患者骨化三醇0．25μg每日睡前口服，共12周。检测患者试验前后的血红蛋白、血细胞比容（HCT）、血肌酐、血白蛋白、血钙、血磷、高敏C反应蛋白（hs—CRP）、白细胞介素6（IL-6）、25-（OH）D3、全段甲状旁腺激素（iPTH）、铁蛋白、血清铁、总铁结合力，计算校正血钙、转铁蛋白饱和度（TAST）及尿素清除指数（Kt／V），同时比较试验前后促红细胞生成素（EPO）的用量。结果1例患者因导管相关性感染于试验开始后4周退出试验，1例患者因急性心肌梗死于10周后退出试验，实际完成试验共计40例。试验后患者血红蛋白、25．（014）D，水平较试验前明显升高，hs—CRP、IL-6水平较试验前明显下降，差异均有统计学意义[（123±11）g/L比（117±11）g／L、（18±8）μg／L比（13±8）μg/L、（2．9±1．8）mg／L比（4．4±4．2）mg／L、（32±9）ng／L比（48±13）ng／L]（均P〈0．05）。EPO用量较用药前有所下降，但差异无统计学意义（P〉0．05）。试验前后患者HCT、血肌酐、血白蛋白、校正血钙、血磷、iPTH、铁蛋白、TAST、Kt／V差异均无统计学意义（均P〉0．05）。结论骨化三醇可以减轻MHD患者的微炎症状态，增加EPO的反应性而减少用量，改善贫血。Objective To observe the clinical effect of active vitamin D supplement on patients with maintenance hemodialysis（MHD）. Methods Forty-two patients with 25-hydroxyvitamin D3 [ 25-（OH） D3 ] deficiency who had MHD in Beijing Jishuitan Hospital from March to June 2015 were enrolled. The patients had calcitriol 0. 25 μg/d at bedtime combined with basic drug treatment and MHD for 12 weeks. Hemoglobin, hematocrit, serum creatinine, albumin, calcium, phosphorus, high sensitivity C-reaction protein （ hs-CRP）, interleukin-6 （IL-6）, 25-（OH）D3, intact parathyroid hormone（iPTH）, ferritin, serum iron and total iron binding capacity were tested before and after treatment; corrected serum calcium, transferrin saturation（TAST） and urea clearance index（Kt/v） were calculated; the dosage of erythropoietin was recorded. Results One patient was excluded after 4 weeks of treatment due to catheter related infection; 1 patient died of acute myocardial infarction after 10 weeks of treatment. Levels of hemoglobin and 25-（OH） D3 in 40 patients after treatment increased significantly compared to those before treatment; leveis of hs-CRP and IL-6 decreased significantly compared to those before treatment [ （123 ± 11）g/L vs （117 ± 11）g/L, （18 ＋ 8） μg/L vs （13 ± 8） μg/L, （2. 9 ± 1.8） mg/L vs （4. 4 ±4. 2） mg/L, （32±9） ng/L vs （48 ± 13）ng/L] （P 〈 0. 05）. The dosage of erythropoietin decreased after treatment without significance difference（ P 〉 0. 05 ）. Levels of hematocrit, serum ereatinine, albumin, corrected serum calcium, phosphorus, iPTH, ferritin, TAST and Kt/V had no significant differences before and after treatment（ P 〉 0. 05 ）. Conclusion Supplement of ealcitriol can alleviate micro-inflammation, reduce use of erythropoietin and improve anemia during MHD therapy.

关 键 词：肾透析 25-羟基维生素D3 微炎症状态 贫血 

分 类 号：R692[医药卫生—泌尿科学]