碳酸镧对维持性血液透析患者钙磷水平的影响及安全性分析

The Analysis of the Effects of Lanthanum Carbonate on Calcium and Phosphorus Levels and Its Safety in Patients Undergoing Maintenance Hemodialysis

目的:分析碳酸镧改善维持性血液透析患者钙磷水平的效果及安全性。方法:将于我院拟行维持性血液透析的患者92例简单随机分组法分为对照组(n=46)与治疗组(n=46),对照组予以碳酸钙治疗,治疗组予以碳酸镧治疗,治疗2个月,比较两组血钙、血磷、全段甲状旁腺激素(iPTH)水平,血清25羟维生素D(25OHD)水平,血管内皮功能的变化情况,并评价其安全性。结果:治疗后,两组血钙、iPTH水平较治疗前无明显变化(P>0.05),血磷水平较治疗前明显降低(P<0.05),治疗组血钙、血磷治疗前后差值均明显大于对照组(P<0.05),两组iPTH治疗前后差值比较无统计学差异(P>0.05);治疗组血清25OHD水平较治疗前明显升高(P<0.05),而对照组无明显变化(P>0.05),治疗组血清25OHD治疗前后差值明显大于对照组(P<0.05);治疗组内皮细胞依赖性舒张功能(FMD)较治疗前明显升高(P<0.05),成纤维细胞生长因子23(FGF23)较治疗前明显降低(P<0.05),对照组FMD、FGF23较治疗前无明显变化(P>0.05),治疗组FMD、FGF23治疗前后差值均明显大于对照组(P<0.05);治疗结束后1周,两组血液、肝肾功能以及心电图复查结果显示为正常范围,治疗期间治疗组与对照组不良反应发生率无明显差异(P>0.05)。结论:碳酸镧用于治疗维持性血液透析患者,比碳酸钙效果显著,可明显降低其血磷水平,升高血清25OHD水平,改善血管内皮功能,且不引起血钙水平变化,安全性较高。

Objective:To analyze the effects and safety of lanthanum carbonate in improving calcium and phosphorus levels in patients undergoing maintenance hemodialysis.Methods:A total of 92 patients who were expecting maintenance hemodialysis were divided into control group(n=46)and treatment group(n=46)with the simple random grouping method.Control group was treated with calcium carbonate,and treatment group was treated with lanthanum carbonate.After 2 months of treatment,levels of blood calcium,blood phosphorus,intact parathyroid hormone(iPTH)and serum 25-hydroxyvitamin D(25OHD)and changes of vascular endothelial function were compared between the two groups.Safety was evaluated.Results:There were no obvious changes in levels of blood calcium or iPTH before and after treatment(P>0.05),but blood phosphorus level was significantly decreased after treatment(P<0.05).The pre-and post-operative differences of blood calcium level and blood phosphorus level in treatment group were obviously greater than those in control group(P<0.05),but the pre-and post-operative difference of iPTH of the two groups was not statistically significant(P>0.05).The serum 25OHD level in treatment group was significantly increased after treatment(P<0.05),but there was no significant change in control group(P>0.05).The pre-and post-operative difference of serum 25OHD level in treatment group was greater than that in control group(P<0.05).The flow-mediated dilation(FMD)in treatment group was significantly increased after treatment(P<0.05)while the fibroblast growth factor-23(FGF23)was significantly decreased after treatment(P<0.05).There were no obvious changes in FMD or FGF23 in control group before and after treatment(P>0.05).The pre-and post-operative differences of FMD and FGF23 in treatment group were greater than those in control group(P<0.05).At 1 week after the end of treatment,the review results of blood,liver and kidney function and electrocardiogram in the two groups were in normal range.There was no significant difference in the incidence rate of adverse reactions between the two groups(P>0.05).Conclusion:Effects of lanthanum carbonate are more obvious than calcium carbonate in the treatment of patients undergoing maintenance hemodialysis.The former can significantly reduce the blood phosphorus level,increase the serum 25OHD level and improve the vascular endothelial function,without causing changes in blood calcium level and with high safety.