碳酸镧对骨化三醇冲击治疗血液透析继发性甲状旁腺功能亢进患者血磷的影响

Effects of lanthanum carbonate on serum phosphorus in maintenance hemodialysis patients receiving calcitriol pulse therapy due to secondary hyperparathyroidism

目的观察碳酸镧在骨化三醇冲击治疗维持性血液透析(maintenance hemodialysis,MHD)患者继发性甲状旁腺亢进时对钙磷代谢的影响。方法选取2013年6月到2016年6月南京大学附属南京鼓楼医院血液透析中心的60例继发性甲状旁腺亢进的MHD患者,并随机分为对照组1、治疗组1[全段甲状旁腺激素在(intact parathyroid hormone,i PTH)300~600pg/ml],对照组2、治疗组2(i PTH在600~1000pg/m L)。对照组1和对照组2分别给予患者口服骨化三醇2.0μg/次,2次/周联合碳酸钙750mg 2次/日和骨化三醇2.0μg/次,3次/周联合碳酸钙750mg 2次/日。治疗组1和治疗组2分别给予口服骨化三醇2.0μg/次,2次/周联合碳酸镧500ug每日3次和骨化三醇2.0μg/次,3次/周联合碳酸镧500ug每日3次,在治疗第4、8、12周末复查i PTH、血钙、血磷。结果与治疗前相比,对照组和治疗组治疗4周、8周和12周的i PTH值均降低(P<0.05);各组患者血钙水平较治疗前均有所上升(P<0.05),但碳酸钙组血钙升高较碳酸镧组血钙升高明显(P<0.05)。碳酸镧组治疗后血磷较治疗前下降(P<0.05);碳酸钙组治疗前后血磷水平比较差异无统计学意义(P>0.05)。结论碳酸镧可有效降低MHD患者合并继发性甲状旁腺功能亢进用骨化三醇冲击治疗时的血磷水平。

Objective To investigate the effect of lanthanum carbonate on calcium and phosphorus me-tabolism in maintenance hemodialysis （MHD） patients treated with calcitriol pulse therapy due to secondary hyperparathyroidism （SHPT）. Methods Sixty MHD patients with SHPT were randomly divided into con-trol group 1 and treatment group 1 （for patients with iPTH 300-600 pg/mL）, and control group 2 and treatment group 2 （for patients with iPTH 600-1000 pg/mL）. Patients in control group 1 were given oral calcitriol of 2μg 2 times/week and calcium carbonate 750mg 2 times/day;patients in control group 2 were given oral calcitriol of 2μg 3 times/week and calcium carbonate 750mg 2 times/day. Patients in treatment group 1 were given oral calcitriol of 2μg 2 times/week and lanthanum carbonate 500μg 3 times/day;those in treatment group 2 were given oral calcitriol of 2μg 3 times/week and lanthanum carbonate 500μg 3 times/day. Serum iPTH, calcium and phosphorus were examined in the treatment period at 4th, 8th and 12th weeks. Results Compared with the levels before treatment, serum iPTH decreased significantly （P〈0.05） and serum calcium increased signif-icantly in the treatment period at 4th, 8th and 12th weeks in control and treatment groups. The increase of se-rum calcium was more in control groups using calcium carbonate than in treatment groups using lanthanum carbonate （P〈0.05）. The decrease of serum phosphorus was more in treatment groups using lanthanum car-bonate than in control groups using calcium carbonate, but without statistical significance （P〉0.05）. Conclu-sion Lanthanum carbonate can reduce serum phosphorus level in MHD patients treated with calcitriol pulse therapy due to SHPT.