空腹与餐中口服碳酸钙对慢性肾功能不全继发甲状旁腺功能亢进钙磷代谢的影响

Influence of different calcium carbonate administration on calcium and phosphorus metabolism of chronic renal insufficiency patients with secondary hyperparathyroidism

目的对比观察空腹与餐中口服碳酸钙两种不同途径对慢性肾功能不全继发甲旁亢患者钙磷代谢的影响,寻找正确应用钙剂的途径。方法将80例慢性肾功能不全继发甲旁亢患者随机分为两组:空腹组及餐中组,观察两组钙磷代谢指标的影响。结果治疗10周后观察:空腹组及餐中组分别与治疗前相比钙均有明显上升(均P<0.01),但两组治疗后组间比较空腹组钙升高明显(P<0.05);空腹组及餐中组分别与治疗前相比磷均有不同程度降低(前者P<0.05,后者P<0.01),但两组治疗后组间比较餐后组磷降低显著(P<0.01);空腹组及餐中组iPTH、AKP分别与治疗前相比均有明显降低(均P<0.01),治疗后组间分别比较均无差别(均P>0.05)。结论慢性肾功能不全继发甲旁亢患者以补钙为目的时应空腹服用为宜。当出现高磷血症时为降低血磷为目的使用钙剂宜采用餐中服用为妥。

[Objective] To observe the effects of different calcium carbonate administration on calcium and phosphorus metabolism and investigate the reasonable administration method for chronic renal insufficiency patients with secondary hyperparathyroidism. [Method] 80 eases of chronic renal insufficiency patients with secondary hypcrparathyroidism were enrolled in our study and randondy divided into 2 therapeutic groups. They were orally administrated calcium carbonate either on an empty stomach （group 1） or during meal （group 2）. The effects on calcium and phosphorus metabolism were recorded and compared between 2 groups. [Results] The level of blood calcium increased significantly 10 weeks after treatment in 2 group （P 〈0.01）, but the level of blood calcium in group 1 increased more than that in group 2 （P 〈0.05）. The level of blood phosphorus decreased 10 weeks after treatment in all the patients （P 〈0.05 in group 1 and P 〈0.01 in group 2）, but phosphorus in group 1 decreased more than that in group 2 （P 〈0.01）. iPTH and AKP of all the patients decreased significant after treatment （P 〈0.01）, but there had no difference between 2 group （P 〉0.05）. [Conclusion] It is rational for chronic renal insufficiency patients with seeondary hyperparathyroidism orally administrate calcium on an empty stomach to supply calcium. If the hypcrphosphatemia is concurrence, it is to administrate calcium during meal for the purpose of decrease blood phosphorus.