司维拉姆治疗慢性肾衰竭维持性血液透析患者高磷血症的疗效

Clinical effect of sevelamer in hyperphosphatemia of chronic renal failure patients with maintenance hemodialysis

目的分析司维拉姆治疗慢性肾衰竭维持性血液透析患者高磷血症的临床疗效。方法以2013年6月—2016年8月间南阳市第一人民医院收治的慢性肾衰竭的高磷酸血症患者80例为研究对象,根据随机数字表法分为观察组和对照组,每组40例。对照组患者给予醋酸钙口服,初始剂量1片/次,3次/d;观察组给予碳酸司维拉姆口服,初始剂量1片/次,3次/d。两组均连续治疗2个月,治疗期间每2周根据血磷水平调整剂量。比较两组治疗前后血磷、血钙、钙磷乘积、全段甲状旁腺激素(i PTH)等有效性指标和临床疗效及白介素(IL)-6、肿瘤坏死因子(TNF)-α和超敏C反应蛋白(hs-CRP)等血清炎症因子的水平和不良反应。结果治疗结束后,两组的血磷、钙磷乘积均较治疗前显著降低,且观察组的显著低于对照组,差异有统计学意义(P<0.05)。治疗结束后,观察组的总有效率为92.50%,显著高于对照组的75.00%,差异有统计学意义(P<0.05)。两组的IL-6、TNF-α以及观察组的hs-CRP均较治疗前显著降低,组内差异有统计学(P<0.05);且观察组的显著低于对照组,组间差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义。结论碳酸司维拉姆治疗慢性肾衰竭维持性血液透析患者高磷血症的临床疗效显著,且可有效降低患者的血清炎症因子,安全可靠。

Objective To investigate the clinical effect of sevelamer in hyperphosphatemia of chronic renal failure patients withmaintenance hemodialysis. Methods Chronic renal failure patients （80 cases） with maintenance hemodialysis andhyperphosphatemia in The First People＇s Hospital of Nanyang from July 2013 to August 2016 were selected and divided intoobservation group and control group, 40 cases in each group. Patients in control group were treated with calcium acetate, and patientsin observation group were treated with sevelamer. The effectiveness indexes （serum phosphorus, serum calcium, calcium-phosphorusproduct and iPTH）, clinical effect, interleukin （IL） 6, tumor necrosis factor （TNF）-ct, hypersensitive c-reactive protein （hs-CRP）, andadverse reaction before and after treatment were compared. Results After treatment, the serum phosphorus andcalcium-phosphorus product of two groups were significantly lower than before treatment （P 〈 0.05）, and the observation group weresignificantly lower than control group （P 〈 0.05）. After treatment, the total effective rate of the observation group was 92.50%,significantly higher than 75% of the control group, and the difference was statistically significant （P 〈 0.05）. The levels of IL-6 andTNF-a in two groups and hs-CRP level in observation group were significantly lower than those before treatment （P 〈 0.05）; Theobservation group was significantly lower than control group, and the difference between two groups was statistically significant （P〈 0.05）. The difference in the adverse reaction rate had no significant between two groups. Conclusion Sevelamer CarbonateTablets have remarkable clinical effect in hyperphosphatemia of chronic renal failure patients with maintenance hemodialysis, andcan effectively reduce the serum levels ofinftammatory cytokines, which is safe and reliable.