碳酸镧与醋酸钙治疗维持性透析患者高磷血症的比较研究

A comparative study of lanthanum carbonate and calcium acetate for the treatment of hyperphosphatemia in maintenance dialysis patients

目的:探讨新型磷结合剂碳酸镧相对于传统磷结合剂醋酸钙用于治疗维持性透析患者高磷血症的疗效及其对于血管钙化的影响。方法:选取80例终末期慢性肾脏病(CKD)维持性透析高磷血症患者,按随机数字表法分为碳酸镧组和醋酸钙组,检测2组患者服药后1、2、4周及4、8、12个月的血磷、血钙、钙磷乘积水平,并于治疗4周及12个月后检测患者甲状旁腺激素(PTH)水平,比较2组患者短期和1年维持期治疗的疗效。测定2组患者1、4、8、12个月的血管钙化程度,分析碳酸镧对于血管钙化的影响。结果:2组患者的血磷在短期内均下降,前2周2组血磷及钙磷乘积差异不明显,但在第4周碳酸镧组血磷及钙磷乘积均低于醋酸钙组(均P<0.01)。维持1年冶疗后,2组血磷和PTH水平无明显差异,均能有效降低血磷,但碳酸镧组钙磷乘积明显低于醋酸钙组(P<0.01);相比于血透患者,碳酸镧组腹透患者的血磷下降更为明显(P<0.05)。血管钙化程度比较,碳酸镧组出现轻度钙化12例,中重度钙化3例,高钙血症0例,总不良影响率为37.5%;醋酸钙组出现轻度血管钙化14例,中重度血管钙化8例,高钙血症8例,总不良影响率为75.0%,差异具有统计学意义(P<0.01)。结论:碳酸镧对于治疗维持性透析患者高磷血症有效,相较于醋酸钙,具有更好的短期疗效,且较少引起高钙血症,更易改善患者的钙磷乘积,其对血管钙化的影响较小。

Objective： To explore the efifcacy and the effects on vascular calciifcation between the new type phosphate binder lanthanum carbonate and traditional phosphate binder calcium acetate for hyperphosphate-mia in patients undergoing maintenance dialysis.Methods： 80 eligible patients were randomly divided into lan-thanum carbonate group and calcium acetate group according to random number table. X-ray measurement was used to evaluate the degree of vascular calciifcation. Serum phosphorus, calcium, calcium-phosphorus product, and PTH were detected to compare the short-term and long-term efifcacy and effects on vascular calciifcation between the two groups.Results： Serum phosphorus of both two groups were decreased in the short term. In the ifrst two weeks of treatment, serum phosphorus and calcium-phosphorus product between two groups were no signiifcant difference. Treatment for 4 weeks, the levels of lanthanum carbonate group serum phosphorus were decreased signiifcantly compared with the calcium acetate group （P〈0.01） and the levels of calcium-phosphorus product were also reduced obviously （P〈0.01）. After 1 year maintenance treatment, the levels of serum phospho-rus and PTH had no obvious difference, both of the two medicine can decrease the levels of serum phosphorus efficiently. However, the calcium-phosphorus product in lanthanum carbonate group was much lower than in calcium acetate group （P〈0.01）; Serum phosphorus of peritoneal dialysis patients in lanthanum carbonate group was decreased more obvious than hemodialysis patients （P〈0.05）. Compared the vascular calciifcation, 12 cases of the lanthanum carbonate group appeared slight calciifcation, moderately severe calciifcation 3 case, hypercal-cemia 0 case, the rate of adverse effects was 37.5%; 14 cases of calcium acetate group appeared mild vascular calciifcation, moderately severe vascular calciifcation in 8 cases, 8 hypercalcemia, the rate of adverse effects was 75.0%. The difference was statistically signiifcant byx2 test （P〈0.01）.Conclusion： Lanthanum carbonate is ef-fective in the treatment of hyperphosphatemia of dialysis patients with better short-term efifcacy, fewer hypercal-cemia and lower calcium-phosphorus product compared to calcium acetate. And it has little inlfuence on vascular calciifcation.