口服醋酸钙和碳酸钙对降低慢性肾衰患者血磷的疗效差异

Efficacy Difference between Calcium Acetate and Calcium Carbonate in Lowering Hyperphosphatemia in Patients with Chronic Renal Failure

目的比较醋酸钙和碳酸钙降低慢性肾衰患者血磷水平的疗效差异;比较汉族和维吾尔族慢性肾衰患者对口服钙剂降低血磷的疗效差异。方法作者医院就诊的慢性肾脏疾病(chronic kidney disease,CKD)4期或血液透析的高磷血症患者共128例,分为醋酸钙维吾尔族组、醋酸钙汉族组、碳酸钙维吾尔族组和碳酸钙汉族组,每组各32例。在停用2周口服钙剂后,根据不同的血磷水平,给予不同剂量的口服钙剂。在开始治疗的0、2、4、8周,检测患者血磷、血钙、血清全段甲状旁腺激素(intact parathyroid hormone,iPTH)水平。评价醋酸钙与碳酸钙降低血磷的疗效差异,同时比较汉族与维吾尔族患者对口服钙剂降低血磷的疗效差异。结果醋酸钙降低血磷的效果优于碳酸钙,表现为血磷降低、钙磷乘积下降、iPTH值降低(P<0.05)。血钙未有明显变化(P>0.05)。不管口服何种钙剂治疗,汉族患者降低血磷的达标率均高于维吾尔族患者(P<0.05)。结论在慢性肾病高磷血症的治疗中,醋酸钙的疗效优于碳酸钙。汉族患者降低血磷的达标率高于维吾尔族患者,这可能和两个民族的饮食结构差异有关。

Objective To compare the efficacy of calcium acetate and calcium carbonate in lowering phosphate levels in patients with chronic renal failure and evaluate the different response to treatments between Han and Uyghur ethnic patients.Methods Patients（n=128）with chronic kidney disease and regular hemodialysis were recruited into the study.They were randomly classified into four groups according to different calcium agents and ethnics with 32 patients in each group.After discontinuation of all calcium agents for two weeks,different dosages of calcium agents were administered for the patients according to their basal serum phosphate levels.The serum phosphate,total calcium and intact parathyroid hormone（iPTH）were measured at 0,2,4,8 weeks after treatment.The effects of calcium acetate and calcium carbonate on lowering the phosphate levels were compared.The possible different responses to treatment between Han and Uyghur ethnic patients were further evaluated.Results Compared with calcium carbonate group,patients treated with calcium acetate had lower levels of serum phosphate,calcium phosphate products and iPTH（P〈0.05）.Regardless of varied calcium agents,patients with Han ethnic had a better response in lowering the serum phosphate than patients with Uyghur ethnic（P〈0.05）.Conclusion Calcium acetate has a higher efficacy in lowering the serum phosphate comparing to calcium carbonate.Patients with Han ethnic have a better response to calcium agents in lowering the serum phosphate than Uyghur ethnic,which may be contributed to different dietary components between two the ethnics.