低钙透析液对血液透析伴继发性甲状旁腺功能减退患者的临床研究

The Study of Low Calcium Dialysate on Hypothyroidism of Maintenance Hemodialysis Patients

目的:探讨应用含钙1.25 mmol/L浓度透析液进行血液透析对维持性血液透析(MHD)伴相继发性甲状旁腺功能减退患者的钙磷代谢和甲状旁腺功能的影响。方法:选择MHD 6个月以上、病情稳定、连续2次血iPTH<100 pg/ml的患者60例,随机分为对照组(含钙1.5 mmol/L透析液)和治疗组(含钙1.25 mmol/L透析液),每组各30例,观察时间6个月。观察并记录研究前、研究后1、3、6个月等不同时期患者血iPTH、血清校正钙、磷、钙磷乘积等指标的变化以及相关不良反应。另外,选择使用含钙浓度1.5 mmol/L和1.25 mmol/L透析液进行MHD的患者各20例,检测单次透析前、透析结束时以及下次透析前的血清校正钙、磷和iPTH浓度。结果:(1)治疗组单次透析后血清校正钙、磷和钙磷乘积均较透析前明显下降,iPTH浓度较透前明显升高,P<0.01;而对照组上述血钙和iPTH浓度无明显变化;(2)透析后治疗组血清校正钙和钙磷乘积较对照组明显下降,血iPTH浓度较对照组明显升高,P<0.01;两组血磷浓度差异无统计学意义。(3)治疗组1个月后血清校正钙、磷和钙磷乘积较治疗前开始下降,3个月后进一步下降,P<0.05,6个月后各项指标趋于稳定;iPTH水平1个月后较治疗前明显升高,并随着治疗时间的延长,逐渐升高,P<0.01。(4)对照组治疗后1、3、6个月上述指标与治疗前比较差异无统计学意义。(5)两组透析过程中出现的不良反应差异无统计学意义。结论:对于血iPTH<100 pg/ml MHD患者应用含钙1.25 mmol/L透析液进行血液透析能较好地控制其血清校正钙、磷、钙磷乘积水平,有效地改善被过度抑制的甲状旁腺功能,并且安全性良好。

Objective：To Study the influence of 1.25 mmol/L calcium dialysate on the calcium - phosphorus metabolism, parathyroid function in the maintenance hemodialysis（MHD） patients who were suffered from relative hypothyroidism that serum intact parathyroid hormone （iPTH） was lower than 100 pg/mlo Methods：60 MHD patients who arc in stable condition over 3 months and two consecutive serum iPTH 〈 100 pg/ml were selected and randomly classified into a control group （ calcium 1.5 mmol/L of dialysate） and a treatment group （calcium 1.25 mmol/L of dialysate）. 30 cases are in each group for observation period of 6 months. The changes of serum iPTH, calcium, phosphorus, calcium and phosphorus product and other indicators and related adverse reactions were Observed and recorded before the study and after 1, 3 and 6 months of the study. In addition, the serum calcium, phosphorus and iFFH concentration of pre - dialysis, post - dialysis and next pre - dialysis were measured in the 20 patients each group of the two groups. Results： （ 1 ） To compared with those of pre - HD, significant lower Serum calcium, phosphorus and calcium - phosphate product and higher serum iPTH concentration of post - HD were in the treatment group, P 〈 0.01. There was no significant difference in above serum calcium and iPTH in the control group. （2）Lower serum calcium and calcium phosphorus product and higher serum iPTH of post - HD in the treatment group were than in the control group（P 〈0.01 ）. There was no significant difference in the serum phosphate between the two groups. （3）In the treatment group, serum corrected calcium, phosphorus, and calcium -phosphate product began to decline after a month and a further decline in three months later,P 〈0.05, the indexes stabilized after 6 months. Serum iPTH level was significantly increased after a month, and gradually increased later （P 〈 0.01 ）. （4）In the control group, there were no significant difference in above laboratory markers for 6 months. （5） There was no magnificent difference in the adverse actions between the groups. Concision：The low calcium dialysate （ 1.25 mmol/L） for the MHD patients whose serum iPTH concentration were 〈 100 pg/ml can prominently control serum calcium, phosphorus and calcium- phosphorus product, effectively improved parathyroid function inhibited much and it is highly safe.