短期应用碳酸镧对持续非卧床腹膜透析患者血磷和成纤维细胞生长因子23的影响

Short-term effects of lanthanum carbonate on serum phosphate and serum fibroblast growth factor 23 in continuous ambulatory peritoneal dialysis patients with hyperphosphatemia

目的研究短期使用碳酸镧治疗持续非卧床腹膜透析(CAPD)高磷血症患者的疗效,及其对血清成纤维细胞生长因子23(FGF23)、α-Klotho蛋白的影响。方法选取使用含钙磷结合剂和活性维生素D的CAPD患者30例,在2周洗脱期后血清磷>1.78 mmol/L,起始给予相同口服剂量碳酸镧片剂治疗,给药第2周根据患者血清磷水平调整药物剂量,疗程为4周。结果共有24例完成随访,均未发生严重不良反应。以血清磷控制在1.78mmol/L以内达标,治疗2周后19例(79.17%)患者血清磷达标,4周后22例(91.67%)达标。治疗后2和4周,患者的血清钙和肌酐水平与治疗前差异均无统计学意义(均P>0.05),血清磷和FGF23水平均较治疗前下降(均P<0.05),血清α-Klotho水平均较治疗前升高(均P<0.05),治疗后2周血全段甲状旁腺激素(iPTH)水平与治疗前差异无统计学意义(P>0.05),但治疗后4周iPTH水平较治疗前下降(P<0.05)。结论碳酸镧可短期内有效纠正CAPD患者的高磷血症,降低患者血清FGF23水平和升高血清α-Klotho水平。

Objective To evaluate the short-term efficacy of lanthanum carbonate on serum phosphate, serum fibroblast growth factor 23（FGF23） and serum-Klotho in treating continuous ambulatory peritoneal dialysis（CAPD） patients with hyperphosphatemia. Methods Thirty patients treated with CAPD containing calcium-phosphorus binder and active vitamin D were selected. Patients with more than 1.78 mmol/L serum phosphorus after two-week washout period were eligible for the study. The same oral dose of strontium carbonate tablets was given for the first treatment; and from the second week, the patients＇ drug dose was adjusted to serum phosphorus level for four weeks. Results A total of 24 patients were followed up, without serious adverse reactions. After two weeks of treatment, serum phosphate of 19 cases（79.17%） was controlled within 1.78 mmol/L and 22 cases（91.67%） met the standard after four weeks. Compared with the baseline level before treatment, two weeks and four weeks after treatment, there were no significant changes in serum calcium and creatinine（all P〈0.05）, and serum phosphorus and FGF23 were significantly decreased（all P〈0.05）,and serum-Klotho increased significantly（all P〈0.05）. There was no significant decrease in i PTH after two weeks,but a significant decrease after four weeks. Conclusion Lanthanum carbonate can control serum phosphorus, reduce the levels of serum FGF23, and increase the levels of serum-Klotho in a short term.