烟酸治疗维持性血液透析患者高磷血症的疗效和安全性分析

Analysis of Curative Effect and Safety of Nicotinic Acid in Treatment of Hyperphosphatemia of Patients with Maintenance Hemodialysis

目的高磷血症是慢性肾脏病常见且严重的并发症,是导致异位钙化和心血管并发症的危险因素。该研究旨在探讨烟酸治疗维持性血液透析患者高磷血症的疗效和安全性。方法将2014年12月—2016年12月期间在该院进行维持性血液透析的60例患者随机分为两组,分为烟酸治疗组和对照组,疗程8周。烟酸剂量600 mg/d(200 mg tid),不能耐受的患者剂量减量至300 mg/d(100 mg tid),共同应用的磷结合剂(碳酸钙600~1200 mg/d)和活性维生素D在研究期间不改变治疗方案。入组前、治疗4周后、治疗8周后分别检测血清钙(CA)、磷(P)、全段甲状旁腺激素(i PTH)、碱性磷酸酶(ALP)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、谷丙转氨酶(ALP)、血小板计数(PLT)等指标。结果烟酸治疗组与对照组在治疗4周和8周后血钙均较前升高,分别由2.33±0.11)mmol/L升至(2.39±0.12)mmol/L(P=0.035)、(2.39±0.12)mmol/L(P=0.021);(2.31±0.10)mmol/L升至(2.37±0.09)mmol/L(P=0.011)、(2.36±0.07)mmol/L(P=0.009),血磷在两组中均有下降,分别为(2.01±0.16)mmol/L降至(1.93±0.15)mmol/L(P=0.004)、(1.86±0.17)mmol/L(P=0.000)和(2.07±0.23)mmol/L降至(2.00±0.26)mmol/L(P=0.000)、(2.00±0.28)mmol/L(P=0.001)。并且组间统计显示治疗组下降更明显(P=0.034)。而对于血脂的影响,烟酸治疗组可以降低甘油三酯、总胆固醇及低密度脂蛋白水平(P=0.034、0.000、0.000),而对照组上述指标下降不明显,对于甲状旁腺激素和碱性磷酸酶以及谷丙转氨酶和血小板计数两组无明显变化。烟酸治疗组中有3例因颜面潮红、麻木退出研究。结论烟酸治疗维持性血液透析患者高磷血症是安全、有效的。

Objective To study the curative effect and safety of nicotinic acid in treatment of hyperphosphatemia of patients with maintenance hemodialysis. Methods 60 cases of patients with maintenance hemodialysis admitted and treated in our hospital from December 2014 to December 2016 were selected and randomly divided into two groups, and the treatment course was eight week, both groups used the phosphate binder（calcarea carbonica 600~1200 mg/d） and activated vitamin D, during the research period, the treatment plan was not changed, the nicotinic acid dose was 600 mg/d（200 mg tid）, and the patients not tolerant decreased to 300 mg/d（100 mg tid）, and the CA, P, Ipth, ALP, TG, TC,HDL, LDL, ALP, PLT, were respectively tested before entry, after four-week and eight-week treatment. Results The blood calcium in the treatment group and in the control group increased after four-week and eight-week treatment increased from（2.33 ±0.11）mmol/L to（2.39 ±0.12）mmol/L（P =0.035）,（2.39 ±0.12）mmol/L（P =0.021）, from（2.31 ±0.10）mmol/L to（2.37±0.09）mmol/L（P=0.011）,（2.36±0.07）mmol/L（P=0.009）, and the blood phosphorus of the two groups decreased, from（2.01±0.16）mmol/L to（1.93±0.15）mmol/L（P=0.004）,（1.86±0.17）mmol/L（P=0.000） and from（2.07±0.23）mmol/L to（2.00±0.26）mmol/L（P=0.000）,（2.00±0.28）mmol/L（P=0.001）, and the decrease in the treatment group was more obvious（P=0.034）,and the nicotinic acid can reduce the triglyceride, total cholesterol and low density lipoprotein levels（P=0.034,0.000,0.000）, and the decrease in the control group was not obvious, and the changes of parathyroid hormone, alkaline phosphatase, glutamic-pyruvic transaminase and platelet count were not obvious, and in the treatment group, 3 cases quitted the study due to blushing and numbness. Conclusion The nicotinic acid in treatment of hyperphosphatemia of patients with maintenance hemodialysis is safe and effective.