低钙透析对血液透析患者血管结构和心脏功能的影响

The effect of low calcium dialysate on vascular structure and cardiac function in hemodialysis patients

目的观察低钙透析对维持性血液透析患者血管结构和心脏功能的影响。方法测定2007年6月至12月在安徽医科大学第三附属医院肾内科血液透析中心30例维持性血液透析(maintenance hemodialysis,MHD)患者,所有患者入组前均使用标准钙1.5mmol/L(dCa2+1.5)透析,透析过程平稳。入组后改用低钙1.25mmol/L(dCa2+1.25)透析液,余治疗方案不变。入组前及改用低钙透析液6个月后行血生化检查。采用GEViVid7型彩色多普勒超声诊断仪检测颈总动脉内膜-中层厚度(intima medial thickness,IMT)、左心室射血分数(lef tventricular ejection fraction,LVEF),测量舒张早期和舒张晚期最大血流速度。并根据公式计算心脏输出指数,舒张早期和舒张晚期最大血流速度的比值(E/A)等指标。结果在使用dCa2+1.25透析液6个月后,患者血清钙值和钙磷乘积与使用dCa2+1.5透析液相比明显下降,甲状旁腺激素(parathyroid hormone,PTH)水平明显上升(P<0.05),有统计学差异,而其它的血清生化指标的变化无统计学差异。使用低钙透析6个月后,患者颈动脉IMT较使用dCa2+1.5透析液相比明显下降,(E/A)比值水平明显上升(P<0.05),而左心室射血分数及心脏输出指数在使用dCa2+1.25透析液6个月后变化无统计学差异(P>0.05)。结论低钙透析可改善维持性血液透析患者动脉粥样硬化和动脉顺应性的下降,促进左室舒张功能,并推测其作用可能与纠正钙磷代谢紊乱有关。

Objective To investigate the effect of low calcium dialysate on vascular structure and cardiac function in hemodialysis patients. Methods Thirty hemodialysis patients were selected in this study from June to December 2007. Standard calcium dialysate solution was changed to lower calcium dialysate solution. The cardiac fuction was echocardiographically examinated at beginning and end of this study respectively. Carotid Intima - Media thickness （IMT） and the parameters of cardiac function were measured by GE ViVid 7 echocardiography. Results Six months after changing to dCa2 1.25, serum calcium concentration decreased, and iPTH increased scientifically （ P 〈 0.05 ）. The changes in Peak E wave velocity / Peak A wave velocity （E/A） and IMT were statistically significant. Conclusion Low calcium dialysate treatment showed favorable changes in vascular structure and cardiac function with maintenance hemodialysis patients. These changes may be associated with the restructure of calcium phosphate metabolism and calcium overload.