药用活性炭有效降低顽固性高磷血症透析患者血磷水平与钙磷乘积

Oral activated charcoal decreases serum phosphate level and calcium phosphorus products indialysis patients with refractory hyperphosphataemia

目的研究口服药用活性炭对未能控制的高磷血症透析患者血磷与钙磷乘积的作用。方法采用单中心、前瞻性、自身前后对照研究。经含钙的磷结合剂治疗后仍存在高磷血症的血液透析或腹膜透析患者，餐中加服药用活性炭4．5～7．2g／d治疗3个月。检测治疗前后血磷、钙、钙磷乘积、全段甲状旁腺激素（iPTH）、白蛋白、血红蛋白水平。用配对t检验进行统计学分析。结果与治疗前比较，治疗3个月后患者血磷水平显著下降[（1．85±0．30）mmol／L比（2．16±0．34）mmol／L，P〈0．01]；血钙磷乘积也相应显著下降[（54．12＋8．37）mga／dl。比（63．93＋8．83）mg2／dl^2P〈0．01]；有更多并发继发性甲状旁腺功能亢进症的患者可以接受维生素D治疗（83．3％比50％）；血钙与iPTH水平无显著性变化（P=0．734，0．665）。活性碳治疗期间血白蛋白水平较前下降[（40．1±2．2）g／L比（41．7±2．9）g／L，P=0．001]。结论顽固性高磷血症透析患者在继续原有磷结合剂治疗基础上，口服药用活性炭可以有效地降低血磷水平与钙磷乘积，对血钙及iPTH水平没有显著性影响。活性炭治疗可使患者血白蛋白水平轻度下降。

Objective To study the effect of medically activated charcoal on serum phosphorus level and calcium-phosphorus products in dialysis patients with poorly controlled hyperphosphatemia. Methods A single-center, prospective, self-controlled study was performed. Medically activated charcoal was administered 4.5-7.2 g per day with meals for three months to hemodialysis or peritoneal dialysis patients with hyperphosphatemia after taking calcium-based phosphate binders. The levels of blood phosphorus, calcium, calcium-phosphorus products, intact parathyroid hormone （iPTH）, albumin and hemoglobin were detected before and after the treatment. The results were analyzed using paired t-test. Results After 3 months of treatment, the patients＇ serum phosphorus level was significantly reduced from （2.16 ±0.34） mmol/L （pre- treatment） to （1.85±0.30） mmol/L （post-treatment） （P〈0.01）. Similarly, the serum calcium- phosphorus products were lowered from pre-treatment level of （63.93 ±8.83） mg2/dl2 to post- treatment of （54.12±8.37） mg2/dl2 （P〈0.01）. Serum albumin level was slightly reduced from （41.7± 2.9） g/L to （40.1±2.2） g/L （P=0.001）. In contrast, there were no significant changes in serum calcium and iPTH levels when compared pre- to post-treatment values （P=0.734 and P=0.665,repectively）. Conclusion In combination with calcium-based phosphate binder therapy, oral medically activated charcoal can effectively reduce the levels of blood phosphorus and calcium- phosphorus products in dialysis patients with refractory hyperphosphatemia.