低分子肝素钙与普通肝素对维持性血透患者钙磷代谢影响的观察

Metabolic Effects of Low Molecular Heparin Calcium and Ordinary Heparin on Calcium and Phosphorus on Chronic Hemodialysis Patients

目的探讨低分子肝素钙对维持性血液透析(MHD)患者钙磷代谢的影响。方法选择在顺德区新容奇医院血透室无明显出血倾向维持血透超过3个月的MHD患者60例,随机分成低分子肝素钙组30例和普通肝素组(UFH)30例。分别观察两组患者在治疗前、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、凝血情况及不良反应等。结果①两组患者治疗前血钙、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iPTH水平逐渐降低,有统计学意义(P<0.05);两组治疗前后血钙和AKP水平均无统计学意义(P>0.05);③LMWH组透析4123人次,各部位出血共发生38人次,发生率为0.92%;UFH组透析3980人次,各部位出血共发生596人次,发生率为14.97%,体外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代谢异常的作用。

Objective To observe the metabolic effects of calcium and phosphorus on chronic hemodialysis patients about low molecular heparin calcium.Methods Choose the maintenance hemodialysis（MHD） patients without obvious bleeding tendency and more than 3 months,60 MHD randomly divided into low molecular heparin calcium（LMWH） group of 30 cases and ordinary heparin group（UFH） 30 cases.Two groups were observed before therapy,3,6 and 12 months of blood serum calcium,phosphate,parathyroid hormone（iPTH）,serum alkaline phosphatase（AKP） level,bleeding,coagulation and adverse reactions,etc.Results ① the two groups of patients in level of serum calcium,phosphate,PTH and AKP were not statistically significant（P0.05）.②With dialysis prolonged,the level of phosphate and iPTH gradually lowering in LMWH groups,which is statistically significant（P0.05）.The level of blood calcium and AKP before and after treatment were no statistically significant in two groups（P0.05）.③There are 4123 dialysis in LMWH group,each part of bleeding is 38,0.92% incidence.There are 3980 dialysis in UFH group,each part of bleeding is 596,14.97% incidence.Which is no statistically significant（P0.05）.Conclusion The long-term use of low molecular heparin anticoagulation can make the metabolic abnormalities of calcium phosphate getting part catabatic in hemodialysis patients.Low molecular heparin may improve metabolic abnormalities.