低甲状旁腺激素水平的血液透析患者应用1.25mmol/L钙浓度透析液的临床观察

The clinical investigation of 1.25mmol/L calcium dialysate in hemodialysis patients with secondary hypoparathyroidism

目的探讨应用1.25mmol/L钙浓度透析液对于低甲状旁腺激素(iPTH)水平的血液透析(HD)患者钙磷代谢及甲状旁腺功能的影响。方法选择北京医院血液净化中心26例血清全段iPTH水平低于100pg/ml的HD患者,应用1.25mmol/L钙浓度透析液,同时停用活性维生素D治疗。观察12个月,比较观察前与3个月、6个月和12个月后血清钙、磷、钙磷乘积及iPTH的变化。结果应用低钙透析液3个月后患者血钙显著下降[(2.63±0.29)mmol/Lvs(2.38±0.13)mmol/L,P<0.05],此后保持稳定,不再继续下降。血磷浓度呈逐渐下降趋势,但差异无显著性。钙磷乘积在进入观察后3个月时已有显著下降[(53.14±13.6)mg2/dl2vs(46.74±9.47)mg2/dl2,P<0.05],此后仍呈下降趋势,但较3个月时差异无显著性。6个月时血清iPTH由观察前的(57.79±36.61)pg/ml升高至(131.12±76.17)pg/ml(P<0.05),此后继续保持此水平。结论1.25mmol/L钙浓度透析液可以降低血钙和钙磷乘积水平,改善被过度抑制的甲状旁腺功能;在维持血钙正常的情况下,较少发生甲状旁腺的过度刺激,适合应用于有高血钙倾向、且钙化危险性增加的低iPTH水平的透析患者。

Objective To investigate the effect of low-calcium dialysate（1.25mmol/L） on calcium and phosphate metabolism and parathyroid hormone secretion in hemodialysis（HD） patients with secondary hypoparathyroidism. Methods Twenty-six HD patients with low level of intact parathyroid hormone （iPTH〈100pg/ml） were treated with 1.25mmol/L calcium dialysate for 12 months. Calcium carbonate were given as phosphrous binder or calcium supplement, and the active Vitamin D were not applied. Results Serum calcium concentrationdecreased significantly from （2. 63±0. 29） mmol/L at baseline to （2.38±0. 13）mmol/L after 3 months and remained in this range thereafter. Calcium-phosphorous product（Ca x P）had the same change as calcium from（53.14±13.67）mg^2/dl^2at baseline to （46.74±9.47）mg^2/dl^2 after 3 months（P〈0.05）, iPTH level increased significantly from baseline （57.79 ± 36.61）pg/ml to a maximum of （131.12 ± 76.17）pg/ ml at 6 months （P〈0.05）,then remained stable. Conclusion The treatment with 1.25mmol/L calcium dialysate effectively decreased serum calcium and Ca x P, stimulated the secretion of parathyroid hormone, and is suitable for HD patients with a relative PTH deficiency, who have tendency to hypercalcemia and calciphylaxis.