低钙透析液对老年血透伴低转化肾性骨病患者骨密度的影响

The effects of low calcium dialysate on bone mineral density in old patients under maintenance hemodialysis with low turnover renal osteodystrophy

目的研究应用含钙1．25mmol／L浓度透析液进行血液透析对老年维持性血液透析（MHD）伴低转化肾性骨病患者骨密度的影响。方法选择MHD6个月以上、连续2次血甲状旁腺激素（iPTH）〈100ng／L的老年患者72例，随机分为治疗组（含钙1．25mmol／L透析液）和对照组（含钙1．5mmol／L透析液），每组各36例，治疗时间12个月。观察患者研究前、研究12个月时血校正钙、磷、钙磷乘积、iPTH和骨密度等指标的变化以及相关不良反应。结果两组患者治疗前一般情况和有关实验室检查差异无统计学意义（P〉0．05）。与研究前以及与对照组比较，治疗组患者使崩含钙1．25mmol／L透析液治疗12个月后平均动脉压（MAP）[（88．6±9．2）mmHg（1mmHg=0．133kPa）比（92．6±10．4）mmHg和（93．7±8．8）mmHg，t=2．052、2．143]、血清钙[（2．4±0．1）mmol／L比（2．6±0．3）mmol／L和（2．6±0．2）mmol／L，t=5．061、5．074]、磷[（2．0±0．2）mmol／L比（2．1±0．2）mmol／L和（2．1±0．3）mmol／L，t=2．276、2．271]、钙磷乘积[（4．7±0．5）比（5．3±0．6）和（5．4±0．7）mmol^2／L^2，t=4．682、4．627]等均明显下降，iPTH[（132．6±37．8）ng／L比（71．3±11．48）ng／L和（69．7±16．0）ng／L，r=8．824、9．048]水平明显升高，骨密度值（腰椎：-0．8±0．9比1．2±1．1和-1．2±1．1，t=2．170、2．170；股骨颈：-0．8±1．0比1．3±1．2和1．3±1．3，t=2．258、2．243）明显增加，差异均有统计学意义（均P〈0．05）。对照组患者使用含钙1．5mmol／L透析液治疗12个月后各项指标无明显变化（P〉0．05）。两组患者研究过程中I叶J现的不良反应差异无统计学意义（P〉0．05）。结论对于血iPTH〈100ng／L的MHD老年患者应用含钙1．25mmol／L透析液进行血液透析能有效地改善被过度抑制的甲状旁腺功能和骨密度低下的状况，较好地控制血校正钙、磷、钙磷乘积水平，并且安全性良好。

Objective To study the effects of low calcium dialysate on bone mineral density （BMD） in old patients with low turnover renal osteodystrophy under maintenance hemodialysis. Methods Totally 72 elderly patients aged ≥60 years under MHD for 6 months or more with parathyroid hormone（iPTH）〈100 ng/I. were selected and randomly divided into treatment group（n= 36,calcium 1.25 mmol/L in dialysate）and a control group（n=36,calcium 1.5 mmol/L in dialysate）, for 12 months of treatment. The changes of albumin-corrected calcium and phosphorus, calcium phosphorus product,iPTH level, bone mineral density, and other indicators as well as related adverse events were observed before and 12 months after the study. Results There was no statistically significant difference in general conditions and the correlated laboratory examinations between the two groups before and after treatment （P〉 0.05）. After dialytic treatments with dialysate containing calcium 1.25 mmol/L for 12 months,the therapy group versus pre-therapy and control group sbowed statistically significant decrease in parameters of mean arterial pressure（MAP）[（88.6±9.2）vs. （92.6±10.4）and（93.7±8.8）mmHg] ,serum calcium（（2.4±0.1）vs. （2.6±0.3）and（2.6±0.2）mmol/L,t=5. 061,5.0743,phosphorus[（2.0±0.2）vs. （2.1±0.2）and（2.1±0.3）mmol/L,t=2.276,2.2713, calcium phosphorus product〈（4.7±0.5）ws. （5.3±0.6） and（5.4±0.7） mmol^2/L^2 ,t=4. 682,4. 6273 （all P〈0.05）, and showed statistically significant increase in parameters of iPTH levels[（ 132.6 ± 37.8）vs. （71.3±11.48）and（69.7±16.0）ng/L;t value 8. 824 and 9. 048, respectively）, bone mineral density values（Lumbar： -0.8±0.9 vs. -1.2±1.1 and 1.2±1.1;t value 2.170 and 2.170, respectivly. Femoral neck： 0.8±1.0 vs. 1.3±1.2 and -1.3±1.3;t value 2.258 and 2.243, respectively） （all P〈0.05）. In the control group after 12 months of treatment with calcium 1.5retool/ L dialysate, there was no significant difference in related parameters （ P〉0. 05 ） . There was no significant difference in the adverse reactions between study and control groups（P〉 0.05）. Conclusions The low calcium dialysate（calcium 1.25 mmol/L）used in elderly patients with iPTH〈 100 ng/L under MHD can effectively improve the excessive depression of parathyroid function and the decreased BMD, and better control the albumin-corrected calcium, phosphorus, calcium phosphorus product level, and has a good security.