碳酸镧联合碳酸钙片对慢性肾功能不全高磷血症患者钙磷代谢的影响

Effects of lanthanum carbonate combined with calcium carbonate tablets on calcium and phosphorus metabolism in the patients with chronic renal insufficiency and hyperphosphatemia

目的观察碳酸镧联合碳酸钙片对慢性肾功能不全(CRI)高磷血症患者钙磷代谢的影响,为该用药方案在未来的应用提供依据。方法选择2018年1月至2019年12月于解放军东部战区总医院治疗的90例CRI高磷血症患者作为研究对象,依随机数字表法分为碳酸镧组、碳酸钙组和联合组,每组30例。在常规治疗基础上,碳酸镧组采用碳酸镧治疗,碳酸钙组采用碳酸钙片治疗,联合组采用碳酸镧联合碳酸钙片治疗,3组均持续治疗12周。比较3组治疗前1 d和治疗结束时的血钙浓度、血磷浓度、血红素氧化酶1(HO-1)水平、颈动脉内膜增厚与钙化斑块形成情况,比较3组治疗期间不良反应发生率。结果治疗结束时,3组血钙浓度由高至低依次为碳酸钙组、联合组、碳酸镧组,3组血磷浓度及HO-1水平由高至低依次为碳酸钙组、碳酸镧组、联合组,差异有统计学意义(P<0.05);治疗结束时,3组颈动脉内膜增厚与钙化斑块形成的例数占比比较,差异无统计学意义(P>0.05);治疗期间,3组头痛、恶心、便秘、呕吐的发生率比较,差异无统计学意义(P>0.05)。结论碳酸镧联合碳酸钙片既能降低CRI高磷血症患者的血磷浓度,又可提升患者的血钙浓度,是改善钙磷代谢的优选用药方案,且不会促进颈动脉内膜病变发生,也不会导致不良反应增多,具有较高的用药安全性。

Objective To observe the effects of lanthanum carbonate combined with calcium carbonate tablets on calcium and phosphorus metabolism in the patients with chronic renal insufficiency(CRI)hyperphosphatemia,and also to provide evidence for future application of medication regimen.Methods Ninety patients with CRI hyperphosphatemia treated in the General Hospital of the Eastern Theater Command from January 2018 to December 2019 were enrolled as research subjects.They were randomly divided into the lanthanum carbonate group,the calcium carbonate group and the combination group,each consisting of 30 patients.On the basis of routine treatment,the lanthanum carbonate group was treated with lanthanum carbonate,the calcium carbonate group treated with calcium carbonate tablets and the combined group treated with lanthanum carbonate combined with calcium carbonate tablets,all with a treatment of 12 successive weeks.The levels of blood calcium,blood phosphorus and heme oxygenase-1(HO-1),as well as ccarotid intima thickening and calcified plaque formation 1 day before treatment and at the end of treatment were detected and compared between the 3 groups.The rates of adverse reactions during treatment were also compared between the 3 groups.Results At the end of treatment,the blood calcium levels of the 3 groups ranking from high to low were the calcium carbonate group,the combined group and the lanthanum carbonate group.The levels of blood phosphorus and HO-1 in the 3 groups ranking from high to low were the calcium carbonate group,the lanthanum carbonate group and the combination group.Results indicated that statistical significance could be found when comparisons were made between them(P<0.05).When the proportion of carotid intima thickening and calcified plaque formation at the end of treatment was compared between the 3 groups,no statistical significance could be seen in them(P>0.05).When the rates of headache,nausea,constipation and vomiting during treatment were compared between the 3 groups,the differences were not statistically important(P>0.05).Conclusion Lanthanum carbonate combined with calcium carbonate tablets could not only reduce blood phosphorus concentration of the patients with CRI hyperphosphatemia,but also increase blood calcium concentration as well.It is the preferred treatment regimen to improve calcium and phosphorus metabolism,and would neither bring about occurrence of carotid artery intima lesions,nor induce increased adverse reactions,with a relatively higher medication safety.