烟酸治疗维持性血液透析伴高钙高磷血症的有效性及安全性

Effectiveness and Safety of Nicotinic Acid for Treating Hyperphosphatemia in Hemodialysis Patients with Hypercalcinemia

目的观察烟酸治疗维持性血液透析同时伴发高钙血症及高磷血症的临床疗效及安全性。方法对经2周洗脱期后血清磷≥1.78 mmol·L-1、血清校正钙≥2.5 mmol·L-1的25例维持性血液透析患者在采用常规治疗基础上给予烟酸口服,观察治疗前及治疗4、8周后血清磷、血清校正钙、钙磷乘积、全段甲状旁腺激素(i PTH)和血碱性磷酸酶、血小板计数、血尿酸、血糖、总胆固醇、三酰甘油、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)的变化。结果与治疗前比较,治疗4周后血清磷及钙磷乘积明显下降(均P<0.05),而血清校正钙、血i PTH、血碱性磷酸酶、血小板计数、血尿酸、血糖及总胆固醇、三酰甘油、HDL-C及LDL-C水平无显著变化(均P>0.05);与治疗4周后比较,治疗8周后使血清磷及钙磷乘积进一步下降(均P<0.01),血i PTH、血碱性磷酸酶、血胆固醇、三酰甘油、LDL-C也显著降低(P<0.05或P<0.01);相反,HDL-C则显著增加(P<0.05)。血清校正钙、血小板计数、血尿酸及血糖未见显著变化(均P>0.05)。结论烟酸可有效降低伴有高钙血症血透患者的血磷水平,改善血脂异常,安全性好。

Objective To evaluate the effectiveness and safety of nicotinic acid for treating hyperphosphatemia in hemodialysis patients with hypercalcinemia. Methods Twenty-five hemodialysis patients with serum phosphorus≥1.78 mmol·L-1 and corrected calcium≥2.5 mmol·L-1 after a 2-week wash-out period were given oral nicotinic acid on the basis of routine treatment. The serum phosphorus, corrected calcium, calcium-phosphorus product, intact parathyroid hormone（iPTH）,alkaline phosphatase, platelet count, uric acid, glucose, total cholesterol, triglyceride, high density lipoprotein cholesterol （HDL-C） and low density lipoprotein cholesterol （LDL-C） were measured before and after treatment for 4 and 8 weeks.Results After treatment with nicotinic acid for 4 weeks, serum phosphorus and calcium-phosphorus product decreased （P〈0.05）, whereas serum corrected calcium, iPTH, alkaline phosphatase, platele count, uric acid, glucose and blood lipid profile remained unchanged （P〉0.05）. Compared with 4 weeks of treatment, 8 weeks of treatment decreased serum phosphorus, calcium-phosphorus product,iPTH, alkaline phosphatase, total cholesterol, triglyceride and LDL-C and increased HDL-C （P〈0.05 or P〈0.01）, but did not affect serum corrected calcium, platelet count, uric acid and blood glucose（P〉0.05）. Conclusion Nicotinic acid can effectively and safely reduce serum phosphorus and improve blood lipid disorder in hemodialysis patients with hypercalcemia.