血液灌流联合西那卡塞治疗血液透析合并高磷血症患者的临床观察  

Clinical observation of hemoperfusion combined with cinacalcet in the treatment of hemodialysis patients with hyperphosphatemia

作　　者：戴静华 姜燕[1] 杜琇 臧秀娟[1] DAI Jing-hua;JIANG Yan;DU Xiu(Department of Nephrology,Shanghai Songjiang District Central Hostpial,Shanghai 201600,China)

机构地区：[1]上海市松江区中心医院肾内科,上海201600

出　　处：《中国处方药》2023年第3期127-129,共3页Journal of China Prescription Drug

基　　金：上海市松江区科学技术攻关项目(19sjkjgg158)。

摘　　要：目的观察血液灌流联合西那卡塞治疗血液透析合并高磷血症患者的临床效果。方法选择76例合并有高磷血症的血液透析(hemodialysis,HD)患者,按照随机数字表法分为对照组与观察组,每组38例。两组患者均予以常规HD治疗,辅以降血压、血脂,纠正水电解质紊乱、贫血等基础治疗,给予饮食调整。在此基础上,对照组单用西那卡塞治疗,初始剂量25 mg,1次/日,监测血钙(Ca)、血磷(P)、全段甲状旁腺激素(iPTH)水平,调整西那卡塞剂量。观察组在此基础上加用血液灌流(hemoperfusion,HP)治疗,每周1次,治疗2 h后移除灌流器,继续单纯透析治疗2 h。两组均治疗8周。比较两组治疗效果;监测治疗前、治疗8周后两组Ca、P、iPTH的变化;同时监测两组治疗的安全性。结果①观察组治疗总有效率为94.74%,高于对照组的65.79%,差异有统计学意义(P<0.05);②治疗8周后,两组Ca、P、iPTH均降低,与治疗前对比差异均有统计学意义(P<0.05);观察组P、iPTH治疗后降低幅度高于对照组(P<0.05),Ca无显著性差异(P>0.05);③两组不良反应发生率对比差异无统计学意义(P>0.05)。结论在血液灌流联合西那卡塞治疗血液透析合并高磷血症情况下,可改善患者钙磷代谢,改善患者预后。Objective To observe the clinical efficacy of hemoperfusion combined with cinacalcet in the treatment of hemodialysis patients with hyperphosphatemia.Methods 76 cases of hemodialysis patients with hyperphosphatemia were selected and divided into the control group and the observation group according to the random number table method,with 38 cases in each group.Both of the two groups were given basic treatment such as reducing blood pressure and blood lipids,correcting water electrolyte disorder and anemia,etc.and were give diet modification.Based on this,the control group was only treated with cinacalcet,initial dose of 25 mg,once a day.Blood calcium(Ca),serum phosphorus(P)and intact parathyroid hormone(iPTH)levels were monitored and the dose of cinacalcet was adjusted.On this basis,the observation group was additionally treated with hemoperfusion,once a week,after 2 hours of treatment,the perfusion device was removed,and the dialysis treatment was continued for 2 hours.Both of the two groups were treated for 8 weeks.The curative effects were compared between the two groups.The changes of Ca,P and iPTH in the two groups before treatment and 8 weeks after treatment were monitored;The safety of treatment in the two groups was also monitored.Results①The total effective rate in the observation group(94.74%)was higher than that in the control group(65.79%)(P<0.05);②8 weeks after treatment,Ca,P and iPTH in the two groups were lower than those before treatment(P<0.05);and after treatment,the decreasing range of P and iPTH in the observation group was greater than that in the control group(P<0.05),but there was no significant difference in Ca(P>0.05);③The difference in incidence of adverse reactions between the two groups were not significant(P>0.05).Conclusion Hemoperfusion combined with cinacalcet in the treatment of hemodialysis patients complicated with hyperphosphatemia can improve the calcium and phosphorus metabolism and prognosis of patients.

关 键 词：血液透析 血液灌流 西那卡塞 高磷血症 钙磷代谢 

分 类 号：R692.5[医药卫生—泌尿科学]