司维拉姆与碳酸钙D3调节慢性肾衰竭血液透析患者钙磷水平的有效性及安全性观察

Efficacy and safety of sevelamer and calcium carbonate D3 in regulating calcium and phosphorus levels in maintenance hemodialysis patients with chronic renal failure

目的观察司维拉姆与碳酸钙D3调节慢性肾衰竭维持性血液透析(maintenance hemodialysis MHD)患者钙磷水平的有效性及安全性。方法选取2018年6月~2019年4月本院血液透析中心慢性肾衰竭MHD治疗患者70例,根据口服降磷药物不同分为观察组和对照组各35例,观察组予碳酸司维拉姆片降磷,对照组予碳酸钙D3片降磷,观察期间两组均根据血磷水平变化调整降磷药物用量,观察疗程均6个月。比较两组患者治疗前后血磷、血钙、钙磷乘积、全段甲状旁腺激素(immunoreactive parathyroid hormone,iPTH)水平,两组总有效率及药物不良反应发生率。结果观察组总有效率明显高于对照组,差异有统计学意义(P<0.05)。两组治疗后血磷、钙磷乘积、iPTH均低于治疗前,差异有统计学意义(P<0.05)。治疗后观察组血磷、钙磷乘积、iPTH水平明显低于对照组,差异有统计学意义(P<0.05)。两组治疗后血钙均低于治疗前,但差异无统计学意义(P>0.05)。治疗后观察组血钙低于对照组,但差异无统计学意义(P>0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论碳酸钙D3与司维拉姆均可有效调节血磷水平,降低MHD患者高磷血症,改善钙磷代谢紊乱,且司维拉姆疗效较碳酸钙D3更明显,两组均未发生严重不良反应,安全性好,适宜临床推广应用。

Objective To observe the effectiveness and safety of sevelamer and calcium carbonate D3 in regulating calcium and phosphorus levels in maintenance hemodialysis patients with chronic renal failure.Methods 70 MHD patients with chronic renal failure treated in our hospital's hemodialysis center from June 2018 to April 2019 were selected.They were divided into observation group and control group,with 35 patients in each group.The observation group was given phosphorus reduction by sevelamer carbonate.And the control group was given calcium carbonate D3 tablets to reduce phosphorus.During the observation period,the dosage of dephosphorization drugs in both groups was adjusted according to changes in blood phosphorus levels,and the observation course was 6 months.The levels of blood phosphorus,blood calcium,calcium-phosphorus product,and total immunoreactive parathyroid hormone(iPTH)before and after treatment were compared between the two groups.The total effective rate and the incidence of adverse drug reactions were compared between the two groups.Results The total effective rate in the observation group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).The blood phosphorus,calcium-phosphorus product,and iPTH after treatment were lower in the two groups than those before treatment,and the differences were statistically significant(P<0.05).After treatment,the blood phosphorus,calcium-phosphate product,and iPTH levels in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).The blood calcium after treatment in both groups was lower than those before treatment,but the difference was not statistically significant(P>0.05).After treatment,the blood calcium in the observation group was lower than that in the control group,but the difference was not statistically significant(P>0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Both calcium carbonate D3 and sevelamer can effectively regulate blood phosphorus levels,reduce hyperphosphatemia in patients with MHD,and improve calcium and phosphorus metabolism disorders.The efficacy of sevelamer is more obvious than that of calcium carbonate D3,and no serious adverse reactions occurred in both groups.They have good safety and are suitable for clinical application.