碳酸镧对非糖尿病维持性血液透析患者血管钙化的影响

Effect of lanthanum carbonate on vascular calcification in maintenance hemodialysis patients without diabetes: a prospective and pilot study

目的探讨长期应用碳酸镧对非糖尿病维持性血液透析(maintenance hemodialysis,MHD)患者血管钙化的影响及可能的机制。方法 60例非糖尿病MHD患者随机分为碳酸镧组(LC组)和碳酸钙组(CC组)各30例,治疗12个月。以多层螺旋CT评价冠状动脉钙化积分(coronary artery calcification score,CACS),比较两组患者治疗前后CACS、磷酸盐代谢、内皮素(endothelin,ET)、成纤维细胞生长因子(fibroblast growth factors,FGF-23)、基质Gla蛋白(matrix gla protein,MGP)、微炎症、血脂及营养状态相关指标变化。应用SPSS 17.0软件包进行统计学分析。结果与基线时相比,LC组12个月时血磷、血钙、FGF23、MGP均显著下降,ET显著升高(P<0.05),而CC组血磷、MGP显著下降,血钙、ET显著升高(P<0.05),FGF23无明显变化。12个月时两组相比,LC组血磷、血钙、FGF23明显低于CC组,MGP明显高于CC组(P<0.05)而两组血压、BMI、ALB、hs CRP、Hb、i PTH、ET和血脂均无显著变化。Pearson相关分析显示两组患者CACS变化与血磷变化(r=-0.720,P=0.000)、FGF23变化(r=-0.480,P=0.000)显著负相关、与MGP变化显著正相关(r=0.600,P=0.000);而与血钙变化、内皮素变化、年龄、透析龄无明显相关(P>0.05)。多元线性回归显示血磷变化、FGF23变化是CACS变化的独立影响因素。结论与碳酸钙相比,碳酸镧能延缓非糖尿病MHD患者血管钙化的进展,可能与碳酸镧能有效控制血磷、使FGF23降低及影响血清MGP水平有关。

Objective To explore the effect of lanthanum carbonate on vascular calcification in mainte- nance hemodialysis （MHD） patients without diabetes. Methods A total of 60 MHD patients treated in Bei- jing Chaoyang Hospital were divided into two groups, the calcium carbonate （CC） group and the lanthanum carbonate （LC） group. We compared the indices of serum calcium, phosphate, fibroblast growth factor -23 （FGF23）, homocysteine, endothelin, matrix gla protein （MGP）, hsCRP, lipids, etc., and evaluated the coronary artery calcification score （CACS） by multi-slice spiral computed tomography at baseline and after the treat- ment for 12 months. SPSS 17.0 for Windows was used for statistical analyses. Results Serum calcium, phosphate, FGF23 and MGP decreased significantly and serum endothelin increased significantly in LC group after 12 months therapy as compared with those at baseline （P〈0.05）. In contrast in CC group, serum phos- phate and MGP decreased significantly, serum calcium and endothelin increased significantly （P〈0.05）, but FGF23 was unchanged after the treatment for 12 months. When comparisons were made between the two groups, serum calcium, phosphate and FGF23 were significantly lower and MGP were significantly higher in LC group than in CC group （P〈0.05）. Pearson＇ s correlation analyses revealed that the change of CACS was negatively correlated with the changes of serum phosphate and FGF23, and was positively correlated with the change of serum MGP in MHD patients without diabetes （P〈0.05）. Changes of serum phosphate and FGF23 were the independent influence factors for CACS change. Conclusions CACS progressed slower in LC group than in CC group. Lanthanum carbonate can decrease serum phosphate, FGF23 but not increase serum calcium as compared with calcium carbonate. In addition, lanthanum carbonate can influence serum MGP level in MHD patients without diabetes.