司维拉姆治疗维持性血液透析高磷血症的疗效观察

Clinical observation of sevelamer in treatment of hyperphosphatemia in maintenance hemodialysis

目的探讨碳酸司维拉姆片治疗维持性血液透析高磷血症的临床疗效。方法选取2018年6月—2019年6月在六安市人民医院治疗的76例血液透析合并高磷血症的患者,将所有患者按照数字随机抽取分为对照组和治疗组,每组各38例。对照组餐中嚼服碳酸钙D3片,1~2次/d,0.6~1.2 g/d;治疗组餐中同服碳酸司维拉姆片,1~2次/d,0.8~1.6 g/d。两组患者连续治疗6个月。观察两组的临床疗效,比较两组患者的血磷、血钙、钙磷乘积、甲状旁腺素(PTH)、白蛋白、血红蛋白水平。结果治疗后,对照组总有效率是57.89%,治疗组总有效率是76.32%,两组总有效率比较差异有统计学意义(P<0.05)。治疗3、6个月后,两组患者的血磷、钙磷乘积较治疗前均下降(P<0.05);且治疗组的血磷、钙磷乘积的下降比对照组更明显(P<0.05)。治疗3、6个月后,对照组血钙显著升高,治疗组血钙呈下降趋势(P<0.05),且治疗组的血钙明显低于对照组(P<0.05)。治疗3、6个月后,两组患者血红蛋白、白蛋白比较均无明显差异。治疗3、6个月后,两组患者PTH均显著降低(P<0.05),但两组的PTH对比无差异。结论碳酸司维拉姆片治疗维持性血液透析高磷血症的疗效较好,可降低患者血磷、钙磷乘积,不引起高钙血症,对患者的营养状况没有影响。

Objective To investigate the clinical study of Sevelamer Carbonate Tablets in treatment of hyperphosphatemia in maintenance hemodialysis. Methods Patients(76 cases) with hyperphosphatemia in maintenance hemodialysis in Lu’an People’s Hospital from June 2018 to June 2019 were randomly divided into control and treatment groups, and each group had 38 cases. Patients in the control group were given Calcium Carbonate and Vitamin D3 Tablets at dinner, 1 — 2 times/d, 0.6 — 1.2 g/d. Patients in the treatment group were given Sevelamer Carbonate Tablets, 1 — 2 times/d, 0.8 — 1.6 g/d. Patients in two groups were treated for 6 months. After treatment, the clinical efficacies were evaluated, and blood phosphorus, blood calcium, calcium phosphorus product, PTH, albumin, and hemoglobin in two groups were compared. Results After treatment, the total effective rate of the control group was 57.89%, and the total effective rate of the treatment group was 76.32%, and the total effective rate of the two groups was statistically significant(P < 0.05). After treatment for 3 and 6 months, the blood phosphorus and phosphorus products of the two groups were decreased(P < 0.05), and the blood phosphorus and phosphorus products in the treatment group were significantly lower than those in the control group(P < 0.05). After treatment for 3 and 6 months, the serum calcium in the control group were significantly increased, but the blood calcium in the treatment group showed a downward trend(P < 0.05), and after treatment for 3 and 6 months, the serum calcium in the treatment group was significantly lower than that in the control group(P < 0.05). There was no significant difference in hemoglobin and albumin between two groups before and after treatment. After treatment, the PTH of the two groups were significantly decreased(P < 0.05), but there was no difference between two groups. Conclusion Sevelamer Carbonate Tablets has clinical curative effect in treatment of hyperphosphatemia in maintenance hemodialysis, can reduce the blood phosphorus, and calcium and phosphorus products, not cause hypercalcemia, and has no effect on the nutritional status of patients.