骨化三醇对维持性血液透析患者贫血及钙磷代谢的影响

Effects of calcitriol on anemia and calcium and phosphorus metabolism in patients with maintenance hemodialysis

目的探讨骨化三醇对维持性血液透析(MHD)患者贫血及钙磷代谢的影响,以期为改善基层医院MHD患者生存质量提供参考。方法根据是否服用骨化三醇胶丸将56例MHD患者分为观察组(n=34)和对照组(n=22)。在血液透析机对症治疗的基础上,观察组给予骨化三醇胶丸口服治疗,对照组给予安慰剂。治疗前及治疗12周后,观察两组患者血红蛋白(Hb),红细胞压积(Hct)、全段甲状腺旁腺激素(i PTH)、血钙、血磷水平及炎性因子高敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平。结果与治疗前相比,治疗后观察组患者Hb、Hct均升高,且明显高于对照组,差异显著(P<0.05);治疗后,两组患者血磷水平均升高,但与治疗前及组间相比无统计学差异(P>0.05);与治疗前相比,治疗后观察组血钙水平升高,且明显高于对照组,差异均显著(P<0.05);治疗后观察组i PTH水平降低,且明显低于对照组(P<0.05);与治疗前相比,观察组hs-CRP、IL-6、TNF-α水平均明显降低,且均明显低于对照组,差异均显著(P<0.01)。结论骨化三醇可能改善MHD患者贫血状态,小剂量使用可维持患者钙磷代谢稳定、有效控制轻度继发性甲旁亢及患者炎症状态,且诱发高钙血症的风险较低,可能有助于改善患者的生命质量。

Objective To investigate the effects of calcitriol on anemia and abnormal calcium and phosphorus metabolism in patients with maintenance hemodialysis(MHD),to provide reference for improving the quality of life of MHD patients in primary hospitals.Methods Fifty-six patients with MHD were divided into observation group(n=34)and control group(n=22)according to whether or not to take Calcitriol Soft Capsules.On the basis of symptomatic treatment of hemodialysis machine,the observation group was given Calcitriol Soft Capsules orally and the control group was given placebo.Before and 12 weeks after treatment,the levels of hemoglobin(Hb),hematocrit(Hct),parathyroid hormone(iPTH),blood calcium,blood phosphorus level and inflammatory factor high sensitive C reactive protein(hs-CRP),interleukins-6(IL-6)and tumor necrosis factor-alpha(TNF-alpha)were observed.Results Compared with before treatment,the Hb and Hct increased in the observation group after treatment,and the difference was significantly higher than that of the control group(P<0.05).After treatment,the level of blood phosphorus in the two groups increased,but there was no statistical difference compared with those before and between the groups(P>0.05).Compared with before treatment,the level of blood calcium in the observation group was higher and significantly higher than that of the control group(P<0.05).The level of iPTH in the observation group was lower than that of the control group(P<0.05),and the level of hs-CRP,IL-6 and TNF-alpha in the observation group were significantly lower than those before the treatment,and all were significantly lower than those of the control group.The difference was significant(P<0.01).Conclusion Calcitriol may improve the status of anemia in patients with MHD.Low dose use can maintain stable calcium and phosphorus metabolism,control mild secondary hyperparahyperthyroidism and inflammatory state effectively,and induce low risk of hypercalcemia,which may help improve the quality of life of the patients.