活性炭联合大黄类制剂协助控制慢性肾脏病高磷血症

Active charcoal combined with zhubarb containing preparation as an adjuvant measure to control hyperphosphatemia in patients on dialysis

目的评价活性炭联合大黄类制剂对常规治疗控制不良的透析患者高磷血症的治疗作用。方法试验设计为多中心前瞻性自身交叉对照试验。选择稳定的血液透析或腹膜透析患者,并存在常规治疗方法不能控制的高磷血症。所有患者维持原有的饮食习惯和基础治疗不变,将患者随机分为治疗组和对照组,治疗组给予爱西特1.5g与三餐同服,肾衰宁胶囊4粒每日3次,根据腹泻和便秘情况调整肾衰宁剂量。治疗1月后交叉,再观察1月。评价治疗是否可降低血清磷水平,以及治疗对白蛋白和血红蛋白的影响。将治疗期前后的生化指标的变化量与对照期前后的生化指标变化量进行自身对照配对t检验。结果共入选50例患者,其中男性24例,腹膜透析患者15例,平均年龄(56±13)岁,平均透析龄(4.9±3.1)年。1例失访、1例入选后用药前出现腹泻、1例饮食极不稳定,没有纳入最终数据分析。治疗可降低血清磷(0.35±0.67)mmol/L(P=0.0010),其中36.2%患者的血清磷水平降低到小于1.78mmol/L,没有发现药物治疗对钙和全段甲状旁腺激素等生化指标的影响。治疗过程中出现3例腹泻和3例便秘,经调整肾衰宁胶囊剂量全部缓解。结论活性炭联合大黄类制剂可协助治疗透析患者高磷血症,为高磷血症的控制提供了一条新途径。由于本研究观察时间短且样本量小,还需要进一步研究证实该治疗方案的长期益处和风险。

Objectives To evaluate the efficacy of active charcoal combined with rhubarb containing preparation in refractory hyperphosphatemia in patients on dialysis. Methods This was a multi-center, prospective and cross-over study. Patients on hemodialysis or peritoneal dialysis with stable disease condition but with hyperphosphatemia （serum phosphate 1.78 mmol/L） that could not be successfully controlled by conventional methods were selected. Patients were randomly assigned into 2 groups. Patients in therapy group received Aixite 1.5 g with meal three times per day, and Shenshuaining, a composite preparation containing rhubarb, 4 pills three times per day. Dose of Shenshuaining was increased or decreased depending on patients＇gastrointestinal symptoms. Patients＇diet habit and other therapies remained unchanged. After 1 month, patients in treatment group were changed to control group, and those in control group to treatment group. Patients were then followed up for another 1 month. Changes of serum phosphate, albumin and hemoglobin between treatment group and control group were compared using paired t test. Results Fifty patients from 6 dialysis facilities were selected, of whom 24 patients were males, and 15 patients were on peritoneal dialysis. The average age and vintage were 56±13 and 4.9±3.1 years, respectively. Three patients were not included in the final analysis： one lost our follow-up, one had diarrhea before the treatment, and one took food unstably. The treatment decreased serum phosphate by about （0.35±0.67）mmol/L （P=0.0010, compared with that of control group）. Serum phosphate level lowered to 1.78mmol/L in 36.2% patients. Serum calcium and iPTH levels did not alter during the treatment period. Diarrhea happened in 3 patients and constipation in 3 patients, and the symptoms released after adjustment of Shenshuaining dose. Conclusions Active charcoal combined with rhubarb containing preparation is effective as an adjuvant measure in control of hyperphosphatemia in patients on dialysis, and provides a new approach for the treatment of hyperphosphatemia. Because the short observation period and small sample size, further study is needed to find out the long term benefits and risks of this regimen.