腹膜透析患者钙磷代谢紊乱临床分析

A Clinical Analysis of the Disorders of Calcium and Phosphorus Metabolism Peritoneal Dialysis Patients

目的探讨生理钙透析液对持续性不卧床腹膜透析(CAPD)患者钙磷代谢的影响。方法回顾性分析2008年1月-2009年12月腹膜透析患者的钙磷指标,资料齐全的患者中使用钙浓度为1.25mmol/L的腹膜透析液(生理钙组)的患者有30例,使用钙浓度为1.75mmol/L的透析液(标准钙组)患者30例。对两组患者钙磷代谢指标进行比较。结果治疗前后两组的血磷、钙磷乘积和全段甲状旁腺素差异均无统计学意义(P>0.05);治疗后标准钙组血钙较前升高,差异有统计学意义(P<0.05),而生理钙组治疗前后血钙差异无统计学意义(P>0.05)。结论不同含钙浓度腹膜透析液对机体钙磷代谢的影响是不同的,在高钙、高磷、低转运骨病的腹膜透析患者中使用钙浓度为1.25mmol/L的生理钙透析液减轻了钙负荷,为临床医生使用含钙磷结合剂提供了治疗空间。

Objective To investigate the effects of physiological calcium dialysate on the calcium and phosphorus metabolism in patients undergoing continuous ambulatory peritoneal dialysis（CAPD）.Methods We retrospectively analyzed the clinical data of 60 patients having undergone CAPD in West China Hospital of Sichuan University between January 2008 and December 2009.The patients were divided into two groups with 30 in each by calcium concentration of the dialysate：the physiological calcium dialysate group（1.25 mmol/L） and the standard calcium dialysate group（1.75 mmol/L）.The metabolism indexes of calcium and phosphorus for the two group of patients were compared.Results Levels of Serum phosphate,calcium-phosphate product and immoreactive parathyroid hormone（iPTH） of all the patients in both groups before and after treatment showed no significant differences（P〉0.05）.Serum calcium increased significantly in patients treated with standard calcium dialysate（P〈0.05）,while it did not change significantly in patients treated with physiological calcium dialysate（P〉0.05）.Conclusions Dialysate with different concentrations of calcium provides different influence on the metabolism of calcium and phosphorus.Changing calcium concentration to 1.25 mmol/L in the dialysate can lower the calcium load for patients with hypercalcium and/or hyperphosphate with low bone turnover,providing treatment space for clinical doctors to use binders containing both calcium and phosphorus.