低浓度钙透析液对维持性血液透析患者继发性甲状旁腺功能亢进及颈动脉粥样硬化的影响

Influence of Low-calcium Dialysate on Secondary Hyperparathyroidism and Carotid Atherosclerosis in Maintenance Hemodialysis Patients'

目的:分析低浓度钙透析液对维持性血液透析患者继发性甲状旁腺功能亢进及颈动脉粥样硬化的影响。方法:收集2013年12月至2015年12月间本院收治的接受维持性血液透析治疗的尿毒症患者76例,按照随机数表法分为对照组(n=38):高浓度钙透析液(DCa1.75),3次/周,持续6月;观察组(n=38):低浓度钙透析液(DCa1.25),3次/周,持续6月。检测两组患者的治疗前及治疗6月后外周血甲状旁腺激素(PTH)及钙磷代谢指标、脂质代谢指标、氧化应激指标含量,超声下颈动脉粥样硬化参数。结果:透析6月后,观察组患者的外周血总钙(t Ca)、离子钙(i Ca)、甲状旁腺激素(PTH)含量低于对照组患者,磷(P)含量高于对照组患者(P<0.05);外周血脂质代谢指标总胆固醇(TC)、三酰甘油(TG)、载脂蛋白B(Apo B)、低密度脂蛋白胆固醇(LDL-C)含量低于对照组患者,高密度脂蛋白胆固醇(HDL-C)含量高于对照组患者(P<0.05);血清超氧化物歧化酶(SOD)含量高于对照组患者,丙二醛(MDA)、活性氧物质(ROS)含量低于对照组患者(P<0.05);超声下颈动脉参数颈动脉内膜中层厚度(IMT)、颈动脉阻力指数(CA-RI)水平低于对照组患者,收缩期血流峰值流速(Vmax)、舒张期血流峰值流速(Vmin)水平高于对照组患者(P<0.05)。结论:对于钙浓度在正常范围的尿毒症患者,低浓度钙透析液的应用有助于维持钙磷及PTH含量的稳定,进一步抑制颈动脉粥样硬化的进展,个体化钙浓度透析液的选择是确保尿毒症患者透析效果、减少严重并发症发生的重要环节。

Objective： To analyze the influence of low-calcium dialysate on maintenance hemodialysis patients＇ secondary hyperparathyroidism and carotid atherosclerosis. Methods： 76 eases of maintenance hemodialysis patients were randomly divided into two groups, control group：high dialysate calcium concentration （DCal.75）, 3 times/week for 6 months; observation groups： low-calcium dialysate （ DCal.25）, 3 times/ week for 6 months. The peripheral blood PTH, calcium and phosphorus metabolism, lipid metabolism, ultrasound carotid artherosclerosis parameters before and after 6 months of two group patients were detected. Results： The PTH, calcium and phosphate metabolism, lipid metabolism, ultrasound carotid atherosclerosis parameters before treatment of two group patients showed no iCa, PTH contents of observation group patients were less P level was higher than control group patients （ P〈0.05 ） ; significant difference （P〉0.05）, The serum tCa, than control group patients after 6 months treatment. lipid metabolism parameters TC, TG,ApoB, LDL-C contents were less than control group patients, HDL-C level was higher than control group patients （ P〈0. 05 ） ; serum content of SOD was higher than that in control group, contents of ROS and MDA were lower than those of control group （P〈0.05） ; carotid ultrasound parameters IMT, CA-RI were lower than control group patients, Vmax, Vmin levels were higher than control group patients （ P〈0.05 ）. Conclusion： For uremic patients, the concentration of calcium in the normal range, apphcation of low calcium dialysate concentration helps to maintain the stability of calcium and phosphorus and the content of PTH, further progress in inhibition of carotid atherosclerosis, individualized dialysate calcium concentration is an important link to ensure the effect of dialysis in uremic patients, reduce serious complications.