调整腹透液钙浓度对尿毒症患者颈动脉粥样硬化的影响

Effect of regulation of dialysate＇s calcium concentration on carotid atherosclerosis in patients under peritoneal dialysis

目的观察调整腹透液钙浓度对持续性不卧床腹膜透析（㈣）患者颈动脉粥样硬化的影响。方法在规律性腹膜透析随访的患者中选择30例伴有颈动脉粥样硬化的患者，先予患者继续使用标准钙腹透液6个月后改用低钙腹透液（Baxter PD4：Ca^2＋1．25mmol／L，其余成分不变），同时增加碳酸钙用量，继续观察12个月，回顾分析患者的血清钙、磷、钙磷乘积及甲状旁腺素（iPTH）水平，颈动脉内-中膜厚度（IMT）、颈动脉血流阻力指数（R1）、颈动脉粥样斑块数量和超声分型的变化。同时观察使用低钙腹透液的不适症状。结果在继续使用标准钙腹透液的6个月中，患者血钙水平逐渐增加，颈动脉IMT增厚，RI增加，差异均有统计学意义。换用低钙腹透液治疗3个月后，颈动脉IMT变薄，RI较前明显下降（P〈0．05），血钙、磷及钙磷乘积明显下降（P〈0．01），iPTH明显增加（P〈0．01）。患者碳酸钙的每日口服剂量也由（2．27±0．41）g增加至（3．35±0．22）g（P（0．05）。在随后的9个月中，血钙、钙磷乘积均稳定在正常范围，血磷降至正常，iPTH 150ng／L左右；颈动脉IMT变薄（P〈0．01）、RI下降（P〈0．01），颈动脉粥样硬化斑块的超声分型及数量变化有统计学意义。治疗过程中，1例死亡，2例自行退出，其余患者均未有明显低钙抽搐、低血压等发生。结论低钙透析能显著减轻腹膜透析患者钙磷代谢紊乱对血管的毒性作用，有助于尿毒症患者颈动脉粥样硬化的转归。

Objective To observe the effect of regulating dialysate＇s calcium concentration on carotid atherosclerosis in uremia patients. Method Thirty CAPD patients with carotid atherosclerosis were selected in this study. After six months of continuing use, standard calcium dialysate solution was changed to low calcium dialysate （Baxter PD4 with calcium concentration 1.25 mmol/1）,oral calcium carbonate was increased at the meantime. Serum calcium, phosphorus, iPTH, carotid intimiamedia thickness（IMT）, hemodynamic parameters, numbers and ultrasound types of carotid athero- sclerotic plaques were observed. Uncomfortable events were recorded at the same time. Results Serum calcium was gradually increased together with significant increased thickness of carotid IMT and increasing RI following six months usage of standard calcium dialysate. After three months of using PD4, carotid IMT became thinner and the resistance index（RI） was decreasd, while serum calcium, serum phosphorus, calcium-phosphorus product all decreased significantly（P〈0. 01）, iPTH increased significantly（P〈0. 01 ）. Meanwhile the dosage of calcium carbonate was increased from（2. 27 ±0. 41 ）g to （3. 35 ± 0. 22）g（P〈0. 05）. In the following nine months, serum calcium concentration, calciumphosphorus product maintained at the normal level, serum phosphorus concentration also decreased to the normal level, iPTH maintained within 150 ng/l. Carotid IMT was also thinner,RI decreased significantly（P〈0. 01）. The ultrasound types and numbers of carotid atherosclerotic plaques also changed significantly. During the treatment, one terminated because of death, two exited on their own accord, others tolerated low calcium dialysate well（no hypotension and no hyperspasmia）. Conclusions Low calcium dialysate can ameliorate the calcium-phsophorus metabolism disturbence and alleviate its toxicity on blood vessels and may be helpful for the outcome of carotid atherosclerotic diseases.