慢性肾衰竭钙磷代谢紊乱的诊断及中西医结合治疗

Diagnosis of calcium and phosphorus metabolism disorder in chronic renal failure and treatment with integrative traditional Chinese and western medicine

钙磷代谢紊乱及其骨病是慢性肾衰竭特别是透析患者的重要并发症之一。长期骨矿物质代谢异常会引起全身血管钙化,与心血管事件的发生及死亡密切相关。2009年改善全球肾脏病预后组织(KDIGO)发布了慢性肾脏病矿物质及骨代谢紊乱(CKD-MBD)的诊断、评估、预防和治疗的临床实践指南,2013年KDIGO新发布的《CKD评估与管理临床实践指南》又针对CKD骨代谢疾病提出了新的观点。治疗的重点是降低高血磷和维持血钙,控制甲状旁腺激素在目标范围。中医治疗慢性肾衰竭钙磷代谢紊乱有独到之处,通过辩证施治,同时结合必要的西药治疗,可显著改善患者的临床生化指标及自觉症状,改善预后。

Calcium and phosphorus metabolism disorder and bone disease are important complications in patients with chronic renal failure especially undergoing dialysis. Long-term metabolism disorder of bone mineral content can cause systemic vascular calcification, which is closely associated with cardiovascular events and mortality. In ：2009, Kidney Disease： Improving Global Outcomes （KDIGO） published the mineral and bone disorder of chronic kidney disease （CKD） guidelines. In 2013, KDIGO proposed some new perspectives about CKD metabolic bone diseases in ＂Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease＂. The treatment for these complications mainly aims to decrease the high blood phosphate, maintain the level of blood calcium, and keep parathyroid hormone （PTH） within defined levels. It is unique for traditional Chinese medicine to treat the calcium and phosphorus metabolism disorder through dialectical therapy and integration with western medicine necessary, which can significantly improve the clinical symptoms, biochemical indices, and the prognosis.