碳酸镧对骨化三醇冲击治疗慢性肾衰竭持续非卧床腹膜透析继发性甲状旁腺功能亢进患者血钙、血磷的影响

Effect of lanthanum carbonate on serum phosphorus in patients undergoing continuous ambulatory peritoneal dialysis(CAPD)with secondary hyperparathyroidism using calcitriol pulse therapy

目的：观察碳酸镧（lanthanum carbonate）在慢性肾衰竭持续非卧床腹膜透析（CAPD）患者应用骨化三醇治疗继发性甲状旁腺功能亢进（SHPT）时对血钙、血磷的影响。方法：将40例血清全段甲状旁腺激素（iPTH）300—500pg／ml、血钙磷乘积〈4．52（mmol／L）2的CAPD患者随机分为2组，每组20例。碳酸镧组给予口服碳酸钢500mg，3次／天，同时口服骨化三醇1．0μg，2次／周冲击治疗；碳酸钙组给予口服碳酸钙750mg，2次／天，同时口服骨化三醇1．0μg，2次／周。结果：碳酸镧组12周后血磷及iPTH较治疗前明显下降，碳酸镧组血钙、血磷明显低于碳酸钙组，差异有统计学意义（P〈0．05）。结论：碳酸镧能有效预防CAPD患者应用骨化三醇冲击治疗SHPT时的高钙血症及高磷血症。

Objective To investigate the effect of lanthanum carbonate on serum calcium and serum phosphorus in chronic renal failure patients undergoing continuous ambu- latory peritoneal dialysis （CAPD） with secondary hyperparathyroidism （SHPT） treated by caleitriol pulse therapby. Methods 40 CAPD patients, with intact parathormone （iPTH） levels of 300～500 pg/ml, calcium X phosphate product 〈4.52 mmol/L were randomly assigned into 2 groups. There were 20 patients in each group. 20 of the pa tients （the lanthanum carbonate group） were treated with oral lanthanum carbonate （500rag, tid） and calcitriol （1.0μg, biw） pulse therapy, the other group （the calcium car- bonate group） were treated with calcium carbonate （750 mg,hid） and caicitriol （1. 0μg, biw）. Serum phosphate, calcium and iPTH were examirLed within 12 weeks of thera- py. Results Serium phosphate and iPTH levels 12 weeks after treatment in the lanthanum carbonate group were significantly lower than those before treatment. The levels of serum calcium and serum phosphate in the lanthanum carbonate group were significantly lower than those in the control group （P〈0.05）. Conclusion I,anthanum carhonate serves as a useful approach for improving hyperealeemia and the hyperphosphatemla in CAPD patients with SHPT using calcitriol pulse therapy.