小剂量骨化三醇联合碳酸司维拉姆延缓维持性血液透析患者血管钙化的效果观察

Effects of Low-dose Calcitriol Combined with Sevelamer Carbonate in Delaying Vascular Calcification in Patients Undergoing Maintenance Hemodialysis

目的观察小剂量骨化三醇联合碳酸司维拉姆延缓维持性血液透析患者血管钙化的效果。方法选取维持性血液透析126例,根据磷结合剂用药方案不同将其分为A、B和C组3组,A组30例给予碳酸钙D 3口服,B组45例给予碳酸司维拉姆口服,C组51例给予小剂量骨化三醇联合碳酸司维拉姆口服。观察比较3组治疗前及治疗8周后血钙、磷及甲状旁腺激素(PTH)浓度,钙磷乘积,冠状动脉和腹主动脉钙化积分,以及治疗期间药物不良反应发生情况。结果治疗前,3组血钙、磷及PTH浓度,钙磷乘积,以及冠状动脉和腹主动脉钙化积分总体比较差异均无统计学意义(P>0.05)。治疗8周后,A、B和C组血钙浓度较治疗前升高,血磷及PTH浓度较治疗前降低;A组钙磷乘积较治疗前升高,B和C组钙磷乘积较治疗前降低;A组冠状动脉和腹主动脉钙化积分较治疗前升高,差异均有统计学意义(P<0.05或P<0.01)。治疗8周后,3组血钙、磷及PTH浓度,钙磷乘积,以及冠状动脉和腹主动脉钙化积分总体比较差异均有统计学意义(P<0.01)。治疗8周后,血钙、磷、PTH浓度及钙磷乘积A组高于B组和C组,B组高于C组;冠状动脉和腹主动脉钙化积分A组高于B组和C组,差异均有统计学意义(P<0.05或P<0.01)。治疗期间,3组药物不良反应发生均较少,仅A组4例、B组1例、C组1例出现恶心、呕吐、腹胀、消化不良和便秘等消化系统反应。结论维持性血液透析患者应用小剂量骨化三醇联合碳酸司维拉姆相较应用碳酸钙D 3和碳酸司维拉姆降低血磷和PTH浓度效果好,且血钙浓度上升幅度小,能够延缓血管钙化。

Objective To observe the effect of low-dose Calcitriol combined with Sevelamer carbonate in delaying vascular calcification in patients undergoing maintenance hemodialysis(MHD).Methods A total of 126 patients undergoing MHD were enrolled and divided into groups A,B and C according to the dosage regimen of phosphate binder.Thirty patients in group A were given oral Calcium carbonate D 3,45 patients in group B were given oral Sevelamer carbonate,and 51 patients in group C took oral low-dose Calcitriol and Sevelamer carbonate.Blood calcium,phosphorus and parathyroid hormone(PTH)concentrations before treatment and at 8 weeks after treatment,calcium-phosphorus product,coronary artery and abdominal aorta calcification scores,and occurrence of adverse drug reactions during treatment were compared among the 3 groups.Results There were no statistically significant differences in blood calcium,phosphorus and PTH concentrations,calcium-phosphorus product and coronary artery and abdominal aorta calcification scores among the 3 groups before treatment(P>0.05).At 8 weeks after treatment,blood calcium concentrations were increased,while the blood phosphorus and PTH concentrations were decreased in all groups.As compared with those before treatment,the calcium-phosphorus product in group A was increased,while the calcium-phosphorus product in groups B and group C were decreased,and coronary artery and abdominal aorta calcification scores in group A were increased(P<0.05 or P<0.01).At 8 weeks after treatment,the differences in blood calcium,phosphorus and PTH concentrations,calcium-phosphorus product and coronary artery and abdominal aorta calcification scores among the 3 groups were statistically significant(P<0.01).Specifically,the order of blood calcium,phosphorus and PTH concentrations,and calcium-phosphorus product in the 3 groups from high to low was as follows:group A,group B,and group C.The coronary artery and abdominal aorta calcification scores of group A were higher than those of group B and group C(P<0.05 or P<0.01).Few adverse drug reactions occurred in the 3 groups during treatment.There were only 4 cases in group A,1 case in group B and 1 case in group C who had mild gastrointestinal reactions such as nausea,vomiting,abdominal distension,dyspepsia and constipation,without any effect on treatment.Conclusion Compared with calcium carbonate D 3 Combined with Sevelamer carbonate,low-dose Calcitriol combined with Sevelamer carbonate has better effects in terms of reducing blood phosphorus and PTH concentrations,with a minimal increase in blood calcium,which also can delay vascular calcification of patients undergoing MHD.