低钙透析液对CAPD患者钙磷代谢的影响

Effect of low calcium dialysate on calcium and phosphate metabolism in continuous ambulatory peritoneal dialysis

目的观察低钙腹膜透析液(1.25mmol/L)(LCD)与标准钙离子浓度(1.75mmol/L)的腹膜透析液(SCD)对CAPD患者钙磷代谢的影响。方法选择血钙高于正常或高钙磷乘积的CAPD患者57例,随机分成两组:SCD组24例;LCD组33例。观察两组患者血钙、磷、镁、全段甲状旁腺激素(iPTH)和皮肤瘙痒情况的变化,及不良反应。观察时间为6个月。结果共53例完成6个月的观察,其中SCD22例,LCD31例。6个月后两组的血钙水平均有所下降,但LCD组血钙水平较前明显下降(P<0.05),SCD组无统计学意义(P>0.05);SCD组患者的血清磷、镁及钙磷乘积无明显变化,而LCD组上述指标明显下降,与SCD组比较具有统计学意义(P<0.05);与SCD相比,LCD组的iPTH水平明显升高(P<0.05);LCD患者皮肤瘙痒情况有所改善,但无统计学意义(P>0.05)。观察期间LCD组患者无低血压、低钙抽搐等情况发生。结论低钙腹膜透析液能够较好控制血钙水平,降低血磷,减轻对甲状旁腺的抑制,可能在预防和改善动力缺失性骨病的发生和发展过程中发挥重要的作用。

Objective To compare the effects of low calcium dialysate （LCD） with standard calcium dialysate （SCD） in patients with continuous ambulatory peritoneal dialysis （CAPD）. Methods Fifty-seven CAPD patients randomly received LCD or SCD for a period of 6 months. Serum calcium was evaluated before and after the treatment for 6 months. Serum phosphate, magnesium and parathyroid hormorne （PTH） were also measured. Uncomfortable events, if any, were recorded. Results Fifty-three patients completed the study. After the treatment for 6 months, serum calcium, phosphate, magnesium and calcium-phosphate product showed no change in the patients receiving SCD （P 〉 0.05）, but decrease significantly in the patients treated with LCD （P 〈 0.05）. Serum PTH increased significantly in patients with LCD as compared with that in patients with SCD （P 〈 0.05）. In patients treated with LCD, skin itch improved, and no hypotension and spasms due to hypocalcemia happened. Conclusions LCD satisfactorily controlled serum calcium, decreased serum phosphate, and alleviated the inhibition of parathyroid. Thus LCD for CAPD may be useful in the prevention of adynamic bone diseases.