摘要
目的观察司维拉姆治疗慢性肾脏病(CKD)合并高磷血症的临床效果及安全性。方法回顾性选取2018年12月—2020年12月于河南大学第一附属医院接受治疗的CKD合并高磷血症患者68例作为研究对象,依据治疗方案不同分为观察组37例和对照组31例。观察组在常规治疗的基础上给予碳酸司维拉姆片,对照组在常规治疗的基础上给予碳酸钙D3片(II),2组均治疗4周。比较2组临床疗效,治疗前后血液生化及血常规指标[血钙、血磷、钙磷乘积、白蛋白(Alb)、血红蛋白(Hb)]、骨代谢指标[甲状旁腺激素(PTH)、碱性磷酸酶(ALP)]、肾功能指标[血尿素氮(BUN)、血肌酐(SCr)、尿酸(UA)]、血脂指标[三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)]及不良反应。结果观察组治疗有效率高于对照组(81.08%vs.58.06%,χ^(2)=4.304,P=0.038)。治疗4周后,2组血磷水平及观察组钙磷乘积下降,且观察组低于对照组(P<0.05或P<0.01);观察组血钙水平与治疗前比较差异无统计学意义(P>0.05),而对照组血钙水平升高,观察组血钙水平低于对照组(P<0.05或P<0.01);2组Alb及Hb水平与治疗前及组间比较差异均无统计学意义(P>0.05);治疗4周后,2组PTH水平及观察组ALP水平降低(P<0.05或P<0.01),但对照组组内ALP水平及2组间PTH、ALP水平比较差异无统计学意义(P>0.05);2组BUN、SCr、UA水平下降(P<0.05或P<0.01),但2组间比较差异无统计学意义(P>0.05);观察组LDL-C水平降低(P<0.01),2组TG、TC水平及对照组LDL-C水平与治疗前比较差异无统计学意义,且2组间TG、TC、LDL-C水平比较无统计学意义(P>0.05)。观察组与对照组不良反应总发生率比较差异无统计学意义(13.51%vs.16.13%,χ^(2)=0.092,P=0.762)。结论司维拉姆治疗CKD合并高磷血症效果较好,可显著降低患者血磷水平,调节矿物质及骨代谢,改善血脂代谢及肾功能,对患者营养状况无影响。
Objective To observe the clinical efficacy and safety of sevelamer in the treatment of CKD complicated with hyperphosphatemia.Methods A total of 68 patients with CKD complicated with hyperphosphatemia who received treatment in the First Affiliated Hospital of Henan University from December 2018 to December 2020 were retrospectively enrolled and divided into the observation group(37 cases)and control group(31 cases)according to different treatment regimens.The control group was given calcium carbonate and vitamin D3 chewable tablets(I)on the basis of conventional treatment,and the observation group was given sevelamer carbonate tablets on the basis of conventional treatment,both groups were treated for 4 weeks.The clinical efficacy,and the blood biochemical and blood routine indexes(serum calcium,blood phosphorus,calcium and phosphorus product,Alb,Hb),bone generation indexes(PTH,ALP),renal function indexes(BUN,SCr,UA),blood lipid indexes(TG,TC,LDL-C)before and after treatment,and adverse reactions of the two groups were compared.Results The total effective rate of the observation group was higher than that of the control group(81.08%vs.58.06%,χ^(2)=4.304,P=0.038).After 4 weeks of treatment,the blood phosphorus levels in both groups and calcium-phosphorus product in the observation group decreased,and the observation group was lower than the control group(P<0.05 or P<0.01).There was no significant change in the blood calcium level in the observation group(P>0.05),while the blood calcium level in the control group was elevated and lower than that in the observation group(P<0.05 or P<0.01).There was no statistically significant difference between the Alb and Hb levels of the two groups compared with those before treatment and between groups after treatment(P>0.05).After 4 weeks of treatment,the PTH level of the two groups decreased,and the ALP level of the observation group decreased(P<0.05 or P<0.01),but there was no significant difference in the ALP level in the control group and the PTH and ALP levels between the two groups(P>0.05).The levels of BUN,SCr and UA decreased in the two groups(P<0.05 or P<0.01),but there was no significant difference between the two groups(P>0.05).The LDL-C levels in the observation group decreased(P<0.01),there was no significant difference in the levels of TG and TC between the two groups and the LDL-C levels in the control group before treatment,and there was no significant difference in the levels of TG,TC and LDL-C between the two groups(P>0.05).There was no significant difference in the incidence of adverse reactions between the observation group and the control group(13.51%vs.16.13%,χ^(2)=0.092,P=0.762).Conclusion Sevelamer has a good effect in the treatment of CKD complicated with hyperphosphatemia,which can significantly reduce the blood phosphorus level,regulate mineral and bone metabolism,improve blood lipid metabolism and renal function,and has no effect on the nutritional status of patients.
作者
焦文温
杨彦伟
蔡灯塔
JIAO Wenwen;YANG Yanwei;CAI Dengta(The First Affiliated Hospital of Henan University,Henan Province,Kaifeng 475001,China)
出处
《临床合理用药》
2026年第2期8-11,25,共5页
Chinese Journal of Clinical Rational Drug Use
基金
河南省医学科技攻关计划联合共建项目(LHGJ20190534)。
关键词
慢性肾脏病
高磷血症
司维拉姆
血钙
血磷
肾功能
Chronic kidney disease
Hyperphosphatemia
Sevelamer
Serum calcium
Serum phosphorus
Renal function
