低钙透析液对腹膜透析患者颈动脉粥样硬化的影响

Low calcium dialysate and carotid atherosclerosis in patients with peritoneal dialysis

目的:观察低钙透析液配合口服碳酸钙及活性维生素D3对持续性不卧床腹膜透析(CAPD)患者颈动脉粥样硬化的影响。方法:30例伴有颈动脉粥样硬化行CAPD的患者,改用低钙透析液(钙1.25mmol/L),同时调整碳酸钙及1,25-(OH)2维生素D3(罗盖全胶丸)的剂量。在改用低钙透析液3、6、9、12月时,采用多普勒超声观察颈动脉内-中膜厚度(IMT)、颈动脉血流阻力指数(RI)、颈动脉粥样斑块数量和超声分型的变化;同时检测血清钙、磷、血清甲状旁腺素(iPTH,放免法),计算钙磷乘积。结果:随访过程中,1例患者死亡,2例患者自行退出。低钙透析液CAPD后,患者颈动脉IMT逐渐变薄,12个月时降至最低[(1.58±0.36)mm,P<0.01]。伴随着颈动脉RI降低,8例患者颈动脉内的扁平斑及软斑数量减少(P<0.05),颈动脉粥样硬化斑块总数量也由47块降至34块。与此同时,血钙、磷及钙磷乘积明显下降(P<0.01),血iPTH明显增加(P<0.01)。至12月时钙、磷、钙磷乘积、iPTH达标比例分别为83.33%、70%、96.67%、70%。碳酸钙的剂量也由(2.27±0.41)g/d增至(3.35±0.22)g/d(P<0.05),罗盖全剂量由(0.21±0.09)μg/d增至(0.33±0.14)μg/d(P<0.05)。患者均未发生低钙抽搐、低血压等。结论:低钙透析有助于尿毒症腹膜透析患者颈动脉粥样硬化的疾病转归,其机制可能与显著改善患者的钙磷代谢紊乱,减轻其对血管的损伤作用有关。

Objective：To observe the effect of dialysis with low-calcium solution in combination with calcium carbonate and alfacalcidol on carotid atherosclerosis in uremia patients. Methodology：Thirty continouos ambulatory peritoneal dialysis patients with carotid atherosclerosis were enrolled in this study. The standard calcium dialysate solution was changed to low calcium dialysate （calcium concentration： 1.25 mmol/L）, calcium carbonate and alfacalcidol was used at the meantime. In the different time （3, 6, 9, and 12 months）, the carotid intimia-media thickness （IMT）, hemodynamic parameters, numbers and ultrasound types of carotid atherosclerotic plaques were observed by doppler ultrasound. The levels of serum calcium, phosphate, iPTH were detected at the same time, and calcium-phosphorus product was also calculated. Results：During our study, one stopped because of death, two exited of their own accord, others 27 cases tolerated low calcium dialysate well. While changing into PD4, the carotid IMT became thinner （ 1.58 ±0. 36 mm） in the 12 th month（P 〈0. 01 ）. Together with the resistance index （RI） decreased, 8 patients＇ ancipital plaque and mollis plaque in carotid were decreased （P 〈0. 05 ）, the numbers of carotid atherosclerotic plaques were also decreased from 47 to 34. The levels of serum calcium, phosphate, and calcium-phosphorus product were all decreased significantly （ P 〈 0. 01 ）, while iPTH was increased significantly （ P 〈 0. 01 ）. The percentages of patients whose serum calcium, phosphate, calcium-phosphorus product and iPTH level reached the target range in month 12 were 83. 33% ,70% ,96. 67%, and 70%, respectively. Meanwhite the dosage of calcium carbonate was changed from （2. 27 ± 0. 41 ） g/d to （ 3. 35 ± 0. 22 ） g/d （ P 〈 0. 05 ）, the dosage of calcitriol was changed from （0. 21 ± 0. 09） μg/d to（0. 33 ± 0. 14） μg/d （ P 〈 0. 05 ）. No hypotension and hyperspasmia happened. Conclusion ： Low calcium dialysate may be helpful to protect the progression of carotid atherosclerotic diseases, possibly because it can ameliorate the calcium-phsophate metabolism disorders to alleviate its damage on blood vessels.