非钙性磷酸盐结合剂的应用进展

Clinical use of non-calcium phosphate binder:an advance

控制血清磷水平对终末期肾病(ESRD)患者非常重要,目前临床普遍使用磷酸盐结合剂来治疗高磷血症。理想的治疗目标在于降低血清磷水平的同时不打破体内钙的平衡,减少药物引起的潜在毒性物质的积累。常用的控制血磷水平的药物有氢氧化铝和钙结合剂等,前者能有效地降低血磷,但金属铝易在体内积累并产生毒性;后者会促进高钙血症和钙超载的发生,加速心血管钙化。因此非铝、非钙类结合剂是当前研究热点,此类药物如司维拉姆、碳酸镧能有效降低血清磷,但由于价格因素未能广泛应用;考来替兰、烟酸和镁盐等新一代的非钙类磷酸盐结合剂,与原有非钙类磷酸盐结合剂相比其价格更便宜,但远期效果及安全性还有待观察。本文详细介绍了各种非钙类磷酸盐结合剂在ESRD中的应用进展,以期对临床用药有所帮助。

Controlling serum phosphorus levels is critical in patients with renal failure. Currently phosphate-binding agents are widely used to reduce phosphate absorption in patients with endstage renal disease. If possible,serum phosphorus level should be reduced without disturbing calcium homeostasis or increasing accumulation of potentially toxic elements. Aluminum hydroxide and traditional calcium -based phosphate binders are commonly used to control serum phosphorus level. Aluminum hydroxide can effectively lower serum phosphorus level,but aluminum can accumulates in the body and results in toxic effect. Traditional calcium-based phosphate binders tend to promote hypercalcemia and calcium overloading,and accelerate cardiovascular calcification. Therefore aluminum -free and calcium-free phosphate-binding agents have become the focus of study; however,agents like sevelamer hydrochloride and lanthanum carbonate are not widely used due to high price,although they are effective in controlling serum phosphorus level. New generation of phosphate binders,such as colestilan,nicotinic acid and magnesium salt,are cheaper than their previous counterparts,but their long -term effect still needs to be observed. This article summarizes the progress of non-calcium phosphate binders in treatment of end-stage renal diseases,hoping to help clinical drug usage.