不同Ca^(2+)浓度透析液对维持性血液透析患者血PTH和CRP的影响

The Influence of Different Ca^(2+) Concentration of Dialysate on Blood PTH and CRP in Maintenance Bemodialysis Patients.

目的探讨3种不同的钙离子浓度的透析液对维持性血液透析患者血钙、钙磷乘积、血PTH及CRP的影响有无不同。方法选择维持性血液透析的≥18岁患者共45例患者,随机分成3组,分别用3种不同含Ca2+浓度透析液进行血液透析3个月,观察病人透析全程的血压变化、有无低钙抽搐、骨痛,在治疗前及治疗3个月时检测其血清钙、磷、iPTH及CRP变化。结果透析3个月后用低Ca2+浓度透析液,患者血清iPTH值较前明显增高,血清CRP值较前明显降低,P<0.05;而高Ca2+浓度透析液可使患者血清iPTH值较前降低,但P>0.05,血清CRP值较前明显增高,P<0.05。结论低钙透析液会降低患者血钙,对血磷无明显影响,可刺激血透患者甲状旁腺激素的分泌,但可减轻尿毒症患者的炎症状态;高钙透析液可加重尿毒症患者的炎症状态。

Objective To investigate the influence of three kinds of different Ca2＋ concentration of dialysate on serum calcium,cal- cium -phosphorus product,serum PTH and CRP in maintenance hemodialysis patients. Methods 45 patients of maintenance hemodialy- sis with ages I〉 18 years were selected. They were divided randomly three groups,and be given three different kinds ofCa2＋ concentration of dialysate to carry out hemodialysis with 3 months. Then the patients＇ variation of blood pressure and whether there were low calcium spasm or ostealgia were abserved during hemodialysis whole range. In addition, changes of their serum calcium ,phosphorus,iPTH and CRP at pretherapy and three months after reatment were also detected. Results After three months of hemodialysis, serum iPTH in patients with low Ca2＋ concentration dialysate increased obviously,and the serum CRP decreased significantly （P 〈 0.05）. But high Ca2＋ concentration dialysate made the patients＇ serum iPTH decrease（ P 〉 0.05 ） , and serum CRP increase notably （ P 〈 0.05 ） as well. Conclusion Low Ca2＋ concentration dialysate can decrease serum calcium with no effect on serum phosphorus, h can also stimulate the secretion of PTH in hemodialysis patients,but alleviate inflammation reaction. High Ca2＋ concentration dialysate could aggravate inflammation reaction in ure- mia patients.