碳酸镧对高钙、高磷维持性血液透析患者钙磷代谢的影响
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篇名: 碳酸镧对高钙、高磷维持性血液透析患者钙磷代谢的影响
TITLE:
摘要: 目的:探讨碳酸镧对高钙、高磷维持性血液透析(MHD)患者钙磷代谢的影响。方法:选择2014年5月-2015年5月我院收治的高钙、高磷MHD患者40例,根据治疗方案分为对照组(22例)和观察组(18例)。两组患者均接受饮食指导、MHD治疗。对照组患者给予铝碳酸镁咀嚼片1 g,餐中嚼服,tid;观察组患者在对照组基础上给予碳酸镧咀嚼片500 mg(血磷≥2.26 mmol/L者)或250 mg(血磷<2.26 mmol/L),餐中嚼服,tid(4周后调整剂量)。两组患者均治疗3个月。观察两组患者治疗前后的钙磷代谢指标[血钙、血磷、钙磷乘积、免疫反应性甲状旁腺激素(iPTH)和碱性磷酸酶]和降磷疗效,并记录不良反应发生情况。结果:治疗前,两组患者的各钙磷代谢指标比较,差异均无统计学意义(P>0.05)。治疗后,对照组患者的钙磷代谢指标和观察组患者iPTH、碱性磷酸酶水平与治疗前比较,差异均无统计学意义(P>0.05);观察组患者血钙、血磷、钙磷乘积均显著低于治疗前,且显著低于对照组同期水平,差异均有统计学意义(P<0.05);观察组患者降磷总有效率(88.89%)显著高于对照组(40.91%),差异有统计学意义(P<0.05)。观察组患者的不良反应发生率(11.11%)与对照组(4.55%)比较,差异无统计学意义(P>0.05)。结论:碳酸镧可显著降低高钙、高磷MHD患者的血钙、血磷水平,且安全性较高。
ABSTRACT: OBJECTIVE: To investigate the effects of lanthanum carbonate on calcium and phosphate metabolism in maintenance hemodialysis (MHD) patients with high calcium and high phosphorus. METHODS: A total of 40 MHD patients with high calcium and high phosphorus in our hospital during May 2014-May 2015 were divided into control group (22 cases) and observation group (18 cases) according to therapy plan. Both groups received diet guidance and MHD treatment. Control group was given Hydrotalcite chewable tablets 1 g, during meal, tid. Observation group was additionally given Lanthanum carbonate chewable tablets 500 mg(for patients with blood phosphorus ≥2.26 mmol/L) or 250 mg (for patients with blood phosphorus <2.26 mmol/L), during meal, tid (adjusting after 4 weeks). Both groups received treatment for 3 months. The calcium and phosphorus metabolism indexes [blood calcium, blood phosphorus, calcium and phosphorus product, immunoreactive parathyroid hormone (iPTH) and alkaline phosphatase] and phosphorus reducing efficacies were observed in 2 groups before and after treatment, and the occurrence of ADR was recorded. RESULTS: Before treatment, there was no statistical significance in calcium and phosphorus metabolism indexes between 2 groups (P>0.05). After treatment, there was no statistical significance in calcium and phosphorus metabolism indexes of control group, iPTH or alkaline phosphatase of observation group compared to before treatment (P>0.05); blood calcium, blood phosphorus, calcium and phosphorus product of observation group were significantly lower than before treatment and also lower than control group at corresponding time, with statistical significance(P<0.05). Total response rate of phosphorus reducing in observation group (88.89%) was significantly higher than control group (40.91%), with statistical significance (P<0.05). There was no statistical significance in the incidence of ADR between observation group (11.11%) and control group (4.55%) (P>0.05). CONCLUSIONS: The lanthanum carbonate can effectively decrease blood calcium and blood phosphorus levels in MHD patients with good safety.
期刊: 2017年第28卷第29期
作者: 覃学,陈文
AUTHORS: QIN Xue,CHEN Wen
关键字: 碳酸镧;维持性血液透析;钙磷代谢;磷结合剂
KEYWORDS: Lanthanum; Maintenance hemodialysis; Calcium and phosphorus metabolism; Phosphate binder
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