低钙腹透液联合低蛋白饮食及复方a酮酸治疗腹透患者高磷血症的疗效研究

Effect study of low-calcium dialysate combined with low-protein diet and compound keto acid in the treatment of hyperphosphatemia in peritoneal dialysis patients

目的 探讨低钙腹透液联合低蛋白饮食及复方a酮酸治疗腹透患者高磷血症的临床疗效.方法 选取2010年2月～ 2014年2月72例高磷血症患者为研究对象,采用数字随机表法分为A、B两组,A组予低钙（钙离子浓度为1.25 mmol/L）腹透液联合低蛋白饮食及复方a酮酸治疗,B组采用氢氧化铝凝胶（2g/d）、碳酸钙（1g/d）口服治疗,观察两组患者治疗前和治疗后2、4、8、12周血磷、钙、钙磷乘积、iPTH、碱性磷酸酶、白蛋白、前白蛋白、血脂等指标的变化,监测不良反应,比较两组患者治疗12周的药效经济学指标.结果 两组患者治疗后8周血P、Ca×P与治疗前、治疗后2周、4周比较,差异有统计学意义（P＜0.05）,但A组患者改善情况优于B组患者,差异有统计学意义（P＞0.05）,A组血血P、Ca×P达标率明显高于B组,差异有统计学意义;两组药效经济学比较,A组低于B组,但差异无统计学意义.两组治疗后血钙、iPTH、AKP与治疗前比较,差异无统计学意义（P＞0.05）;治疗前Tb、Aib、BUN、Scr、TG与治疗后2、4、8、12周指标比较,差异无统计学意义（P＞0.05）,均在正常范围内,治疗后TC下降,治疗后8周与治疗前、治疗后4周见差异均有统计学意义（P＜0.05）.结论 低钙腹透液联合低蛋白饮食及复方a酮酸能降低高磷血症,改善高脂血症,且不影响患者营养状态,安全性高;和常规治疗比较,药效经济学无统计学差异。

Objectives To explore the effect of low-calcium dialysate combined with low-protein diet and compound keto acid in the treatment of hyperphosphatemia in peritoneal dialysis patients.Methods 72 hyperphosphatemia patients admitted from 2010.2 to 2014.2 were selected and randomly divide into group A and group B.Group A was given low-calcium dialysate（concentration of intracellular was 1.2.Smmol/L） combined tith low-protein diet and compound keto acid,group B was given aluminium hydroxide gel（2g/d）,calcium carbonate（1g/d）.The observation indexes were the changing of serum phosphorus,calcium,calcium and phosphorus product,iPTH,alkaline phosphatase,albumin,prealbumin and serum lipid before treatment and 2-,4-,8-,12-weeks after treatment.Monitoring the adverse reactions and comparing pharmacoeconomic indexes after 12-weeks treatment.Results Serum P and Ca × P after 8-weeks treatment were statistically significant in compared with before treatment,2-and 4-weeks after treatment （P 〈 0.05）,but group A was improved better than group B,the difference was statistically significant.The achieved rate of serum P and Ca x P in group A was obviously higher than group B with statistically significance.The pharmacoeconomic comparison of two groups had no difference.The serum Ca,iPTH and AKP were no difference in before and after treatment （P 〉 0.05）.Tb,Aib,BUN,Scr and TG were no difference in before and 2-,4-,8-and 12-weeks after treatment （P 〉 0.05）,and all of them were in normal range.TC were decreasing after treatment,and 8 -weeks after treatment were statistically significant in compared with before treatment and 4-weeks after treatment（P 〈0.05）.Conclusions Low-calcium dialysate combined with low-protein diet and compound keto acid could improve hyperphosphatemia and hyperlipemia without affecting the nutrition conditions of patients,which is safety and has no statistically significance in pharmacoeconomic comparing with regular treatment.