低分子肝素钠对血液透析患者钙磷代谢影响的临床观察

Clinical observation of low molecular weight heparin on calcium-phosphate metabolism in maintenance hemodialysis patients

目的探讨低分子肝素钠对维持性血液透析(MHD)患者钙磷代谢的影响。方法选择在上海市闸北区中心医院肾内科血液净化中心无明显出血倾向透析龄超过3个月的MHD患者78例,随机分成低分子肝素钠(LMWH)组38例和普通肝素(UFH)组40例。分别观察二组患者在治疗前、治疗后3、6、12个月的血钙、血磷、血清甲状旁腺激素(iPTH)、血清碱性磷酸酶(AKP)的水平。同时观察患者出血、体外循环的凝血情况及不良反应等。结果①二组患者治疗前血钙、血磷、PTH、AKP水平无统计学意义(P>0.05);②LMWH组随着透析时间延长,血磷及PTH水平逐渐降低,有统计学意义(均P<0.05);UFH组随着透析时间延长,血磷、PTH水平治疗前后无明显变化(P>0.05);二组治疗前后血钙和AKP水平均无统计学意义(均P>0.05);③LMWH组透析5708例次,各部位出血共发生58例次,发生率为1.02%;UFH组透析6012例次,各部位出血共发生1310例次,发生率为21.8%,6例患者退出UFH组。LMWH组的出血发生率较UFH组明显降低(P<0.01),二组体外循环凝血发生率无统计学意义(P>0.05)。结论长期使用低分子肝素抗凝,可使血液透析患者所存在的钙磷代谢异常得到部分缓解,提示低分子肝素可能有改善钙磷代谢异常的作用。

Objective To observe the effect of low molecular weight heparin （LMWH） on calcium-phosphate metabolism in maintenance hemodialysis （MHD） patients. Methods We recruited 78 patients who had undergone hemodialysis for at least three months without hemorrhage risk, and were randomly divided into LMWH treatment group （38 cases） and unfractionated heparin （UFH） treatment group （40 cases）. Serum calcium, phosphate, parathyroid hormone （PTH） and alkaline phosphatase （AKP） were measured. Changes of bleeding, coagulation status in the extracorporeal circuit, and adverse effects were recorded. Results In the 12 months of treatment, lower serum levels of phosphate and PTH were observed in LMWH group （P 〈 0.05 for phosphate and PTH）, but not in UFH group （P 〉 0.05）. Serum calcium and AKP had no differences between the 2 groups （P 〉 0.05）. Bleeding was more in UFH group than in LMWH group （P 〈 0.01）, leading to the change of heparin treatment in 6 cases in UFH group. Conclusion LMWH used as the anticoagulant in hemodialysis may associate with the improvement of calcium-phosphate metabolism in MHD patients.