摘要
目的探讨新进入血液透析的13例患者使用活性维生素D和低钙透析液(含钙1.25mmol/L)治疗继发性甲状旁腺功能亢进的疗效及不良反应。方法选择北京医院肾内科13例患者首先使用低钙透析液透析,根据继发性甲状旁腺功能亢进的程度给予活性维生素D治疗;观察7～18个月,记录血钙、磷、钙磷乘积和iPTH的变化及其它不良反应。结果治疗2个月时,13例患者血钙明显升高,iPTH水平显著降低(P<0.05);钙磷乘积和血磷有所增高(P>0.05);在结束观察时,钙磷乘积和血磷较治疗前显著增高(P<0.05),血钙、磷和钙磷乘积较治疗2个月时增高(P>0.05);11例患者的iPTH在150～320pg/ml范围波动,2例患者iPTH出现反弹。13例患者对低钙透析液的耐受性良好。结论活性维生素D和低钙透析液对新进入血液透析患者的继发性甲状旁腺功能亢进治疗效果良好,对于透析前磷高而钙不低的患者,推荐使用低钙透析液,可减少因服用含钙的磷结合剂所致体内钙负荷增加的危险,达到降低血钙磷乘积和减少心血管钙化的目的。
Objective To investigate the effect and adverse reaction of active vitamin D and low calcium dialysate on secondary hyperparathyroidism in 13 new hemodialysis patients. Methods Hemodialysis with low calcium dialysate（1.25mmol/L） was applied for 13 patients first. AS to calcium-phosphorus product less than 55mg^2/dl^2, therapy of active vitamin D was begun according to the severities of hyperparathyroidism. Serum calcium, phosphorus, calciumphosphorus product, iPTH and other side effects were observed. Results After 2 months of treatment, serum calcium markedly elevated from （8.37±0.82）mg/dl to （9.24±0.97）mg/dl（P〈 0.05）. There was no significant difference in the change of serum phosphorus and calciumphosphorus product. The iPTH significantly declined from （590.8±274.0）pg/ml to（305.3±227.9） pg/ml（P〈0.05）. Following 5-16 months, serum phosphorus （5.54± 1.06）mg/dl and calcium phos phorus product （51.43 ± ll.4）mg^2/dl^2 were apparently higher than pre-therapy（P〈0.05）. The lever of serum calcium, phosphorus and calcium-phosphorus product were somewhat higher than those after 2 months of treatment. The iPIH of 11 patients fluctuated between 150±320 pg/ml, 2 patients did not achieve fine effect, 13 patients endured well to low calcium dialysate, there were no adverse reaction including muscle spasm, hypotension or arrhythmia. Conclusions Therapy of active vitamin D and low calcium dialysate on secondary hyperparathyroidism in new hemodialysis patients is effective. It is recommended to use low calcium dialysorus for those patients whose serum phosphorus is high and calcium is not too low. Using of available calciumcontaining phosphorus binders witch could increase to patients calcium load and low calcium dialysate may reduce calcium-phosphorus product without enhancing the risk of cardiovascular calcification.
出处
《中国血液净化》
2006年第5期242-244,280,共4页
Chinese Journal of Blood Purification
