碳酸镧在维持性血液透析患者高磷血症中的应用研究

Study on application of lanthanum carbonate in maintenance hemodialysis patients with hyperphosphatemia

目的探讨碳酸镧对伴有高磷血症的维持性血液透析(maintenance hemodialysis,MHD)患者磷酸盐代谢、微炎症、血脂及营养状态的影响。方法 80例伴有高磷血症的MHD患者随机分为碳酸镧组和碳酸钙组各40例,治疗12周。比较两组患者治疗前后磷酸盐代谢、微炎症、血脂及营养状态相关指标变化。结果在第12周末碳酸镧组皮肤瘙痒评分、血钙、磷、钙磷乘积、成纤维细胞生长因子23(fibroblast growth factor 23,FGF23)较基线显著下降(P<0.05),1,25二羟基维生素D[1,25-Dihydroxy vitamin D,1,25(OH)_2D]较基线显著升高,并与碳酸钙组相比有显著变化(P<0.05);碳酸钙组第12周末血钙及钙磷乘积与基线相比显著升高(P<0.05),而血磷、FGF23、1,25(OH)_2D无显著变化。结论碳酸镧能显著降低血磷、FGF23,使1,25(OH)_2D升高,而全段甲状旁腺激素(intact.parathyroid hormone,iPTH)、血清25羟维生素D[25-hydroxyvitamin D,25(OH)D]、血脂、微炎症及营养状态未受影响。

To explore the effects of lanthanum carbonate on phosphate metabolism, micro inflammation, blood lipids and nutritional status of MHD with hyperphosphatemia. Method 80 cases of MHD with hyperphos- phatemia from Beijing Chaoyang hospital were randomly divided into calcium carbonate group and lanthanum carbonate group with 40 cases in each group, which were all treatment for 12 weeks. The index＇ s changing of phosphate metabolism, micro inflammation, blood lipids and nutritional status of two groups before and after treatment were compared. Result At the end of the twelfth week, comparing with baseline, the skin pruritus score, the level of serum calcium and serum phosphorus, calcium phosphorus product and FGF23 were decreased significantly （P 〈 0.05 ） , the levels of sermn 1,25 （OH）2 O was increased significantly and had significant changes compared to calcium carbonate group（P〈0.05 ）. The levels of serum calcium and calcium phosphorus product in ealcium carbonate group were increased significantly compared to baseline at the end of the twelfth week, but its levels of serum phos- phate, FGF23 and 1,25 （OH）2D were not changed significantly（ P〈0.05 ）. Conclusion Lanthanum carbonate can significantly reduce the levels of serum phosphate and FGF23, and increase the levels of serum 1,25 （OH）2 D, but it cannot affect the level of iPTH ,25 （ OH）D, micro inflammation and serum lipid.