口服磷结合剂在透析患者中的疗效观察

Efficacy observation of oral phosphate binders in patient with hemodialysis

目的:通过监测血清钙、磷及甲状旁腺激素(parathyroidhormone,PTH)水平,观察不同类型的磷结合剂对维持性血液透析中高磷血症患者钙磷代谢的影响。方法:选取高磷血症的透析患者60例,随机分为4组,A组患者予以安慰剂,B组患者予以口服碳酸钙(300mg Bid),C组患者予以碳酸镧(500mg Bid),D组患者予以氢氧化铝(300mg tid),持续4周。结果:1与治疗前相比,B、C、D3组患者血磷水平均明显下降(P<0.01);A组患者血钙出现明显上升(P<0.01);B、C组患者钙磷乘积显著下降(P<0.01)。2组间比较,C、D组患者在降低血磷、钙磷乘积及PTH水平较B组更为显著(P<0.05)。结论:3种不同类型的磷结合剂均能有效降低血磷、血PTH水平,但碳酸钙组容易导致患者血钙升高,临床上需根据患者的实际需要来选择合适的药物。

Objective：To observe the effects of different types of phosphate binders for the maintenance hemodialysis patients with hyperphosphatemia, by measuring the levels of the serum calcium, phosphorus and parathyroid hormone （ PTH） . Methods：Sixty hemodialysis patients with hyperphosphatemia were investigated. The patients were divided into four groups randomly. Group A re-ceived placebo, Group B orally took calcium carbonate （300mg Bid）, Group C was given lanthanum carbonate （500mg Bid）, and Group D was given aluminium hydroxide （300mg tid）. Results：1. Compared with those before the treatment, the levels of the serum phosphorus was obviously reduced in Group B, C and D （P〈0. 01）;the level of the serum calcium increased in Group A （P〈0. 01）;the level of the calcium-phosphorus product was significantly reduced in Group B and C （P〈0. 01）. 2. Compared among the four groups, Group C and Group D were more significant than group B in reducing serum phosphorus, calcium-phosphorus product and PTH levels （P〈0. 01）. Conclusions： All the three different types of phosphate binders can effectively reduce the serum phosphorus and PTH levels, but calcium carbonate can easily lead to hypercalcemia clinically. Therefore, we should choose the appropriate drugs according to patients＇ serum calcium and serum phosphorus levels.