低钙透析液联合骨化三醇的应用对钙磷水平的影响

Influence of the Application of Low-Calcium Dialysate in Combination with Calcitriol in Serum Calcium-Phosphorus Levels

目的 对比不同钙浓度透析液联合骨化三醇治疗后血Ca、P、钙磷乘积（Ca×P）及甲状旁腺激素（PTH）水平的变化。方法 维持性血液透析（MHD）患者随机分为DCa 1.25与DCa 1.5组，每组18例。依PTH水平不同，给予不同剂量的骨化三醇冲击治疗，记录2组治疗前、治疗1、3、6个月血清Ca、P、Ca×P、PTH及骨碱性磷酸酶（BAP）水平，并观察收缩压（SBP）、舒张压（DBP）的变化。结果2组血Ca、P及Ca×P处理效应与时间效应间存在交互作用（P〈 0.05），随治疗时间的延长，DCa 1.25与DCa 1.5组分别呈逐渐降低和增高的趋势，并均于治疗3~6个月趋于稳定。2组在血PTH、BAP指标中处理效应与时间效应不存在交互作用；单纯处理效应和时间效应亦无统计学意义。血清PTH水平随治疗时间的延长，DCa1.5组呈逐渐升高趋势；DCa1.25组于治疗3个月基本趋于稳定并呈逐渐降低趋势。SBP处理效应与时间效应存在交互作用，DBP的处理效应与时间效应无交互作用；2组不同处理效应治疗前后SBP水平差异有统计学意义，DCa 1.25组随着治疗时间的延长，SBP缓慢降低，治疗3、6个月减低趋势显著。结论DCa1.25透析液联合骨化三醇的长期应用可降低血Ca水平并维持在正常低限，增加MHD患者对活性维生素D3及碳酸钙的耐受性，使SBP降低。

Objective To observe the changes of serum calcium, phosphorus, calcium-phosphorus product and para thyroid hormone （PTH） levels after treatment with different concentrations of calcium dialysate in combination with calcitriol. Methods Thirty-six patients on maintenance hemodialysis were randomly divided into Dcal.25 group and Dcal.5 group, 18 cases in each group. Patients took different doses of ealcitriol on the different values of PTH basis. Changes of serum calcium, phosphorus, calcium-phosphorus product, PTH and bone alkaline phosphatase （BAP） levels were recorded respectively on four time points from prior treatment and 1, 3 and 6 months of therapy. The leveis of systolic blood pressure （SBP） and diastolic blood pressure （DBP） were also observed. Results There was an interaction between treatment effects and time effects in serum calcium, phosphorus, calcium-phosphorus product levels in two groups （P 〈 0.05）. With the dura tion of treatment, there was a trended to decrease and increase respectively in DCa 1.25 group and DCa 1.5 group, and trend- ed to stabilize for therapy 3 to 6 months. There was no interaction between serum PTH and BAP levels and time effects in two groups. There was no statistical difference in simple treatment effects and time effects. The serum PTH level showed a trend of increase gradually in DCal.5 group with the duration of treatment. In DCa 1.25 group, the serum PTH level trended to stabilize after 3-month therapy and showed a trend of decrease gradually. There was an interaction between treatment effects and time effects in SBP in two groups, but no interaction in DBP. There was a significant difference in SBP before and after treatment in two groups. The level of SBP reduced tardily with time of treatment and reduced significantly after 3 and 6 -month therapy. Conclusion The application of DCal.25 dialysate in combination with calcitriol decreased serum calci- um effectively and kept the lower limit of normal value, which increased tolerability of active vitamin D and calcium carbon- ate therapy, and decreased SBP in maintenance hemodialysis patients.