生理钙腹膜透析液对钙磷代谢达标及血管钙化影响的研究

Effects of physiological calcium peritoneal dialysis on the disorders of serum calcium and phosphorus metabolism and vascular calcification

目的:探讨生理钙腹膜透析对患者钙磷代谢紊乱和心血管钙化的影响。方法:2009年1月至2015年6月在我院规律随访大于12个月的134例腹膜透析患者,根据使用透析液钙离子浓度不同分为高钙透析组、生理钙透析组。比较患者治疗12个月前后的钙磷代谢情况、心脏超声及血管钙化等相关指标。结果:71例高钙透析组患者在治疗12个月后,其血钙水平显著高于使用生理钙透析组的58例患者(P<0.01)。高钙透析组患者在治疗12个月后,其血钙、冠脉积分、腹主动脉积分水平较基线水平升高程度显著高于生理钙透析组患者(P<0.05)。5例患者随访中由高钙透析液转为生理钙透析液,在更换为生理钙透析液治疗12个月后,患者血钙显著降低、iPTH明显升高(P<0.05)。与高钙透析组患者比较,生理钙透析组和高钙转生理钙透析组患者在治疗12个月后,活性维生素D的使用和血钙达标的比例显著高于前者(P<0.05)。高钙转生理钙透析液的5例患者在改用生理钙透析液后患者的iPTH达标率显著增加(P<0.05)。结论:与高钙透析液相比,使用生理钙透析液有利于维持腹膜透析患者血钙的达标,改善iPTH代谢,并延缓血管钙化的进程。

Objective: To investigate the calcium-phosphorus metabolism and cardiovascular system in patients using physiological calcium peritoneal dialysis fluid. Methods: A total of 134 peritoneal dialysis patients who had been followed-up for more than 12 months were divided into high calcium dialysis group and physiological calcium dialysis group according to the types of dialysate they used. After 12 months of treatment,the general situation,serum levels of calcium and phosphorus and the indices of cardiac ultrasound and vascular calcification were compared between the two groups. Results: After 12 months of treatment,the serum calcium level was significantly increased in high calcium dialysis group( P < 0. 01). The increments of serum calcium,calcification scores of coronary arteries and abdominal aorta were more prominent in the high calcium dialysis group than those in the physiological calcium dialysis group( P < 0. 05). For the 5 patients who had changed their dialysate from high calcium to physical calcium,the 12-month treatment of physical calcium dialysate made their serum calcium significantly decreased and the iPTH level markedly increased( P < 0. 05). As compared with the patients in high calcium group,those in physical calcium group and the five patients who had switched to physical calcium dialysate had a higher proportions of vitamin D administration and a more ideal serum calcium level. After patients replaced their dialysis therapy from high calcium dialysate to physical calcium dialysate,the standard-reaching rate of serum iPTH and calcium increased. Conclusions: Physical calcium dialysate are helpful for the patients to maintain ideal serum calcium and improve iPTH variation,and delay the aggregation of vascular calcification.