低钙腹膜透析液对尿毒症患者颈动脉粥样硬化的影响

Effects of low calcium dialysate on carotid atherosclerosis in uremic patients

目的探讨低钙腹膜透析（PD）液对尿毒症患者颈动脉粥样硬化的影响及机制。方法将60例行连续性非卧床腹膜透析（CAPD）且合并颈动脉粥样硬化的患者随机分为A组（标准钙PD液治疗组，30例）和B组（低钙PD液治疗组，30例），均继续行正规CAPD治疗。观察治疗12周前后患者颈动脉内-中膜厚度（IMT）及颈动脉粥样硬化斑块发生率的变化，同时生化法检测血清钙浓度，ELISA法测定血清基质金属蛋白酶-9（MMP-9）水平。结果经过12周的分组透析后，B组患者的血清钙、MMP-9[（2．25±0．24）mmol／L、（564．72±124．69）μg／L]较A组患者[（2．40±0．37）mmol／L、（718．56±111．83）μg／L]明显下降（P〈0．05），颈动脉IMT[（1．17±0．28）mm]亦显著低于A组[（1．25±0．19）mm]（P〈0．05）。结论低钙PD液可延缓尿毒症患者颈动脉粥样硬化的进展，其对血清MMP-9的影响可能是其机制之一。

Objective To investigate the effects of low calcium dialysate on carotid atherosclerosis in uremic patients and its mechanisms. Methods 60 patients who undertook continuous ambulatory peritoneal dialysis（CAPD） were divided into two groups： Group A（standard calcium dialysate, n = 30）,Group B（low calcium dialysate, n = 30）, observing carotid intimia-media thickness （IMT）, incidence of carotid atherosclerotic plaques before and after 12 weeks＇ treatment, serum calcium was detected and MMP 9 was determined by ELISA at the same time. Results After 12 weeks＇ treatment, the serum calcium and serum MMP-9 levels of group B were （2. 25 ± 0. 24）mmol/l, （564. 72 ± 124. 69） μg/1 respectively while those of group A were （2. 40 ± 0. 37）mmol/1, （718. 56 ± 111.83）μg/1. The difference was significant（P〈0. 05）. At the same time, carotid IMT of group B was （1.17 ± 0. 28）mm which was lower than that of group A whose was（1.25 ± 0. 19）mm（P〈0. 05）. Conclusions Low calcium dialysate can decrease the level of serum MMP-9, which may be helpful to delay the progression of carotid atherosclerosis.