碳酸司维拉姆对慢性肾衰竭合并高磷血症患者微炎症状况及预后的影响  

Effect of Sevelamer Carbonate on Microinflammation and Prognosis in Patients with Chronic Renal Failure Complicated with Hyperphosphatemia

作　　者：贺丹[1] 陆志峰 陆静娟 HE Dan;LU Zhifeng;LU Jingjuan(Changshu Second People's Hospital,Jiangsu Changshu 215500,China)

机构地区：[1]江苏省常熟市第二人民医院肾内科

出　　处：《河北医学》2019年第11期1850-1854,共5页Hebei Medicine

基　　金：江苏省卫生厅资助基金项目,(编号:20150107243)

摘　　要：目的:探讨碳酸司维拉姆对慢性肾衰竭合并高磷血症患者微炎症状况及预后的影响,探讨其微炎症状况及治疗措施。方法:选取我院2017年8月至2018年8月收治的80例慢性肾衰竭合并高磷血症患者展开研究。按照简单随机分组法,将患者随机均分为观察组(40例),对照组(40例)。对照组在常规血液透析治疗基础上联合碳酸钙治疗,观察组在常规血液透析治疗基础上联合碳酸司拉姆治疗。治疗4周后,比较两组患者治疗前后的肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素6(IL-6)、血磷、血钙、甲状旁腺激素(iPTH)水平及两组患者的不良反应发生率。结果:治疗后,两组患者的TNF-α、CRP、IL-6水平均较治疗前明显降低,且观察组各项指标水平均显著低于对照组(P<0.05);两组患者血磷、iPTH、钙磷乘积明显降低(P<0.05),观察组各项指标水平显著低于对照组,差异有统计学意义(P<0.05);两组患者的血钙、碳酸氢盐水平明显升高,对照组的血钙水平明显高于观察组,对照组的碳酸氢盐水平明显低于观察组,两组比较差异有统计学意义(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。结论:碳酸司维拉姆在慢性肾衰竭合并高磷血症患者治疗过程中,效果显著。不仅能够有效降低患者炎症因子水平,而且能调节血磷血钙水平,安全性良好。Objective:To investigate the effect of Sevelamer carbonate on microinflammation and prognosis in patients with chronic renal failure complicated with hyperphosphatemia,and to explore its microinflammation status and treatment measures.Methods:80 patients with chronic renal failure complicated with hyperphosphorus were selected from August 2017 to August 2018 in our hospital.The patients were divided into observation group(40 cases)and control group(40 cases),according to the simple random grouping method.The control group was treated with calcium carbonate on the basis of routine hemodialysis,while the control group was treated with calcium carbonate on the basis of routine hemodialysis.Four weeks after treatment,the levels of TNF-alpha,CRP,IL-6,blood phosphorus,calcium and parathyroid hormone(iPTH)and the incidence of adverse reactions were compared between the two groups before and after treatment.Results:After treatment,the levels of TNF-a,CRP and IL-6 in the two groups were significantly lower than those before treatment,and the levels of each index in the observation group were significantly lower than those in the control group(P<0.05);the levels of blood phosphorus,iPTH,calcium-phosphorus product in the two groups were significantly lower(P<0.05),and the levels of each index in the observation group were significantly lower than those in the control group(P<0.05).The difference was statistically significant(P<0.05);the levels of serum calcium and bicarbonate in the two groups were significantly higher than those in the control group,and the level of bicarbonate in the control group was significantly lower than that in the observation group(P<0.05);there was no statistical difference in the incidence of adverse events between the two groups(P<0.05).Conclusion:Sevelamer carbonate can effectively reduce the level of inflammatory factors and regulate the level of blood phosphorus and calcium in patients with chronic renal failure combined with hyperphosphatemia,with good safety.

关 键 词：慢性肾衰竭 高磷血症 碳酸司维拉姆 碳酸钙 白细胞介素 

分 类 号：R47[医药卫生—护理学]