磷结合剂对于血液透析高磷血症患者成纤维细胞生长因子23水平的影响

Effect of lanthanum carbonate vs. calcium carbonate on serum FGF-23 levels in maintenance hemodialysis patients with hyperphosphatemia

目的比较碳酸镧和碳酸钙对于血液透析高磷血症患者血清成纤维细胞生长因子23（fibroblast growth factor-23，FGF-23）水平的影响。方法选择我科56例慢性肾衰竭维持性血液透析患者，入选患者血磷〉1．77mmol／L，血钙〈2．38mmol／L，25-OH—VitDTk平〉30ng／ml，血白蛋白水平〉30g／L。患者限制饮食磷摄人量为1000mg／d左右，将患者随机分为2组，分别接受碳酸镧或碳酸钙治疗16周。每2周常规检测血钙、血磷水平，滴定磷结合剂的使用剂量，使血磷水平达标。在治疗的第0、4、16周检测血清FGF-23及iPTH水平。结果碳酸钙和碳酸镧均能降低血磷水平。2组中，血清校正钙离子水平、甲状旁腺素水平均无明显变化。与碳酸钙相比，碳酸镧能有效降低FGF-23水平，且血磷水平的改变与血清FGF-23水平的改变呈正相关。结论在血液透析患者中应用碳酸镧可以有效降低血磷及血清FGF-23水平，而应用碳酸钙并不能减少血清FGF-23水平。

Objective To compare the effect of lanthanum carbonate vs. calcium carbonate on serum FGF23 levels in maintenance hemodialysis （MH） patients with hyperphosphatemia. Methods Fifty-six patients subject to MH from our nephrology outpatient clinic were enrolled：serum phosphorus 〉 1.77 mmol/L, serum calcium〈2. 38 mmol/L, 25-OH-VitD levels〉30 ng/ml, and serum albuminS30 g/L. Patients were given dietary restriction of phosphate（about 1 000 mg/day） and ran- domized in a 1 ： 1 ratio to receive either lanthanum carbonate or calcium carbonate for 16 weeks. Blood samples were obtained for routine evaluation of serum calcium and phosphate at 2 week intervals; the dose of phosphate binders was adjusted to maintain serum phosphate to reach the target. Serum FGF- 23 and iPTH levels were measured at weeks 0,4 and 16 administered with lanthanum carbonate or cal- cium carbonate for 4 months. Results Serum phosphorus levels were significantly reduced in both groups. In contrast, corrected serum calcium levels and the serum parathyroid levels showed no signifi- cant changes. Serum levels of FGF23 in lanthanum carbonate group were lower than in calcium car- bonate group. There was significant correlation between the changes of serum FGF-23 and serum phos- phate. Conclusions In MH patients, lanthanum carbonate is effective in reducing serum phosphorus levels and FGF23 levels. However, calcium carbonate does not reduce FGF23 levels.