维生素C透析液对继发性甲状旁腺功能亢进的影响

The effect of dialysate containing vitamin C on secondary hyperparathyroidism

目的了解维生素C透析液对维持性血液透析患者继发性甲状旁腺功能亢进的影响。方法选择在郑州大学第一附属医院血液净化中心长期透析的患者82例,随机分成两组,分别使用常规透析液(A组40例)和含维生素C透析液(B组42例)进行血液透析,周期为3个月,试验开始前及3个月后分别于透析前抽血化验血清全段甲状旁腺素(intact parathyroid hormone,iPTH)、钙、磷、钙磷乘积、碱性磷酸酶(alkaline phosphatase,ALP)、维生素C水平。结果 A组试验3个月后血清iPTH、ALP轻度升高,钙、磷、钙磷乘积无明显变化,差异无统计学意义(P>0.05),维生素C降低,差异有统计学意义(t=-2.35,P<0.05);B组试验3个月后血清iPTH、ALP明显降低,差异有统计学意义(P<0.05),钙、磷、钙磷乘积无明显变化,维生素C轻度升高,差异无统计学意义(t=0.14,P>0.05)。结论常规透析使大量维生素C丢失;维生素C可以降低血清iPTH、ALP,预防继发性甲状旁腺功能亢进。

Objective To comprehend the effect of vitamin C-containing dialysate on secondary hyperpar-athyroidism in patients on maintenance hemodialysis （MHD）. Methods Eighty-two stable MHD patients were enrolled in this study,and they were randomly assigned into group A or group B. Patients in group A （40 cases） used regular dialysate,and those in group B （42 cases） used vitamin C-containing dialysate for MHD for 3 months. Serum intact parathyroid hormone （iPTH）,Ca,P,Ca x P product,alkaline phosphatase （ALP） and vitamin C were measured before and after a hemodialysis session at the beginning and end of vitamin C-containing dialysate therapy period. Results In group A after using regular dialysate for 3 months,serum iPTH and ALP increased slightly,serum Ca,P,Ca x P product showed no obvious changes,but serum vitamin C decreased significantly （t=-2.35,P〈0.05）. In group B after using vitamin C-containing dialysate for 3 months,serum iPTH and ALP decreased significantly （P〈0.05）,serum Ca,P and Ca x P product showed no obvious changes,and serum vitamin C increased slightly （t=0.14,P〉0.05）. Conclusions MHD using regular dialysate may cause large amount loss of vitamin C. MHD using vitamin C-containing dialysate may result in the decrease of serum iPTH and ALP,thus prevent the patients from secondary hyperparathyroidism.