不同钙浓度腹膜透析液对长期CAPD患者矿物质和骨代谢影响的分析

Analysis of the effects of dialysate calcium concentrations on mineral and bone metabolism in patients with long-term CAPD

目的观察腹膜透析液钙离子浓度对持续性不卧床腹膜透析(CAPD)患者矿物质和骨代谢的影响。方法回顾性分析我院腹膜透析中心行CAPD治疗2年以上的123例患者,根据腹膜透析液钙离子浓度分为低钙腹膜透析液组(LCD组,钙离子浓度为1.25 mmol/L)和标准钙腹膜透析液组(SCD组,钙离子浓度为1.75 mmol/L),观察不同钙浓度腹膜透析液对患者血清钙、磷、全段甲状旁腺激素(i PTH)、颈动脉厚度、心脏瓣膜钙化及骨痛、皮肤瘙痒等情况的影响。使用SPSS 18.0统计软件包进行数据处理。结果 2组患者治疗前人口学特征、腹膜转运特性、钙磷代谢等指标的基线水平差异无统计学意义(P>0.05)。治疗2年后,2组患者血钙浓度及达标率较治疗前均显著增高(P<0.05),SCD组血钙浓度增幅高于LCD组,但差异无统计学意义(0.26±0.31 mmol/L与0.17±0.29 mmol/L,t=1.621,P=0.108);2组间治疗后血清钙、磷、i PTH平均水平及其达标率、颈动脉厚度、心脏瓣膜钙化比例、骨痛及皮肤瘙痒累计发生率差异均无统计学意义(P>0.05);LCD组活性维生素D使用比例显著高于SCD组(χ2=6.373,P<0.05)。结论采用低钙与标准钙腹透液治疗2年,对CAPD患者矿物质和骨代谢的影响无显著性差异。

Objective To investigate the effects of dialysate calcium concentrations on on mineral and bone metabolism in patients with continuous ambulatory peritoneal dialysis （CAPD）. Methods A retrospective analysis was made in our hospital for more than two years in 123 patients with CAPD treatment, who were divided into low calcium dialysate （ECD） group （calcium concentration 1.25 mmoi/L） and standard calcium dialysate （SCD） group （calcium concentration 1.75 mmol/L） to observe their effects on serum calcium, phosphorus, intact parathyroid hormone （ iPTH）, bone pain, pruritus, thickness of carotid arteries, and heart valve calcification. Results There were no differences in baseline levels of demographic characteristics, peritoneal transport characteristics, and calcium phosphorus metabolism between the two groups （P 〉 0.05 ）. After 2 years of treatment, serum calcium concentration and the target-reaching rate significantly increased in the two groups compared with those before treatment （P 〈 0.05 ）, and the calcium concentration of SCD group was higher than that of the LCD group but without statistical significance （0.26 ± 0.31 mmol/L vs 0. 17 ± 0.29 mmol/L, t = 1. 621 ,P = 0. 108） ; and the differences between the two groups after treatment were not statistically significant in the serum calcium, phosphorus, the average level of iPTH and its targetreaching rate, carotid artery thickness, cardiac valve calcification proportion, bone pain, and cumulative incidence rate of skin itching （ P 〉 0.05 ） ; but the proportion of active vitamin D use in LCD group was significantly higher than that in the SCD group χ2 = 6. 373, P 〈 0.05 ）. Conclusion The treatment of CAPD with different dialysate calcium concentrations for 2 years did not have any significant effects on the mineral and bone metabolism of patients.