碳酸司维拉姆对维持性血液透析患者血尿酸及血脂的影响  

Effect of sevelamer carbonate on serum uric acid and lipids in patients with maintenance hemodialysis

作　　者：刘聪慧 刘小菁[1] 曹倩颖 侯明冉 袁丹[1] 金立群 焦建[1] 李忠心[1] Liu Conghui;Liu Xiaojing;Cao Qianying;Hou Mingran;Yuan Dan;Jin Liqun;Jiao Jian;Li Zhongxin(Department of Nephrology,Beijing Luhe Hospital,Capital Medical University,Beijing 101100,China)

机构地区：[1]首都医科大学附属北京潞河医院肾病中心,101100

出　　处：《北京医学》2019年第4期263-266,共4页Beijing Medical Journal

摘　　要：目的评价碳酸司维拉姆对维持性血液透析(maintenance hemodialysis, MHD)患者血尿酸(serum uric acid,SUA)及血脂的影响。方法选取2018年1～10月于首都医科大学附属北京潞河医院规律血液透析,应用碳酸钙治疗及严格控制饮食后血磷仍未达标的患者30例。所有患者停用碳酸钙,改为碳酸司维拉姆800 mg(3次/d),随餐口服。记录患者治疗前、治疗4周及8周时的实验室指标。结果应用碳酸司维拉姆治疗8周后,患者SUA[(383.33±53.15)μmol/L vs.(414.43±68.81)μmol/L,P<0.001]、TC[(3.62±0.83)mmol/L vs.(3.86±0.82)mmol/L,P=0.003]、LDL-C[(2.06±0.67)mmol/L vs.(2.23±0.63)mmol/L,P=0.003]、血钙[(2.23±0.14)mmol/L vs.(2.29±0.17)mmol/L,P=0.032]及血磷[(1.96±0.39)mmol/L vs.(2.47±0.39)mmol/L,P<0.001]较治疗前均显著下降,而HDL-C、TG、全段甲状旁腺激素(intact parathyroid hormone,iPTH)、Hb、ALB、SCr、BUN的变化差异无统计学意义(P>0.05)。基线SUA≥420μmol/L的患者SUA水平下降更为显著[(53.77±44.50)μmol/L vs.(13.76±20.61)μmol/L,P=0.003]。结论碳酸司维拉姆可有效纠正高磷血症,降低钙负荷,同时具有降低SUA、TC及LDL-C的多重效应。Objective To evaluate the effect of sevelamer carbonate on serum uric acid(SUA) and lipids in patients with maintenance hemodialysis(MHD). Methods The patients undergoing hemodialysis in Beijing Luhe Hospital from January to October 2018 were reviewed. A total of 30 patients with hyperphosphatemia were included after the application of calcium carbonate treatment and strict diet control. All patients were discontinued calcium carbonate and replaced by sevelamer carbonate(800 mg three times daily). Laboratory indicators were recorded at baseline, four weeks and eight weeks. Results After eight weeks of treatment with sevelamer carbonate, SUA [(383.33 ± 53.15)μmol/L vs.(414.43 ± 68.81)μmol/L, P<0.001], TC [(3.62±0.83) mmol/L vs.(3.86±0.82) mmol/L, P = 0.003], LDL-C [(2.06±0.67) mmol/L vs.(2.23±0.63) mmol/L,P= 0.003], serum calcium[(2.23±0.14) mmol/L vs.(2.29±0.17) mmol/L, P = 0.032] and serum phosphorus [(1.96±0.39) mmol/L vs.(2.47±0.39) mmol/L, P<0.001] decreased significantly compared with baseline. While serum level of HDL-C, TG, intact parathyroid hormone(iPTH), hemoglobin, albumin, creatinine and urea nitrogen kept steady. The SUA level decreased more significantly in patients with baseline SUA≥ 420 μmol/L [(53.77±44.50)μmol/L vs.(13.76±20.61)μmol/L, P = 0.003].Conclusions The improvements in serum calcium, multiple lipid surrogates and serum uric acid in this study show that sevelamer carbonate is a promising therapy for treatment of hyperphosphataemia in MHD patients.

关 键 词：碳酸司维拉姆 维持性血液透析 血尿酸 血脂 

分 类 号：R692.5[医药卫生—泌尿科学]