司维拉姆与醋酸钙片联合应用治疗维持性血液透析者高磷血症的疗效分析

Efficacy Analysis of Sevelamer Combined with Calcium Acetate Tablets in the Treatment of Hyperphosphatemia in Maintenance Hemodialysis Patients

目的评价司维拉姆与醋酸钙片联合应用治疗维持性血液透析者高磷血症的疗效。方法对该院2017年4月—2019年4月收治的维持性血液透析合并高磷血症患者进行筛选,从中随机选择100例患者作为该次研究的对象,盲选法随机分为两组,每组50例。对照组采用醋酸钙片治疗,研究组采用司维拉姆与醋酸钙片联合治疗。治疗15 d后,观察两组患者治疗前后血脂指标、血清磷、钙磷乘积、血清全段甲状旁腺激素、碱性磷酸酶与不良反应。结果治疗后,研究组低密度脂蛋白(1.67±0.25)mmol/L、高密度脂蛋白(1.09±0.17)mmol/L、血清磷(1.76±0.32)mmol/L、血清钙(2.19±0.19)mmol/L,钙磷乘积(3.41±0.53)mmol/L、血清全段甲状旁腺激素(3.91±0.62)pmol/L优于对照组的(1.88±0.23)mmol/L、(1.18±0.14)mmol/L、(2.05±0.29)mmol/L、(2.28±0.20)mmol/L、(3.59±0.55)mmol/L、(4.53±0.67)pmol/L,差异有统计学意义(t=4.371、2.890、4.748、2.307、3.762、4.803,P<0.05);治疗期间,研究组不良反应发生率4.00%低于对照组18.00%,差异有统计学意义(χ^(2)=5.005,P<0.05)。结论对维持性血液透析合并高磷血症患者采用醋酸钙片及司维拉姆联合治疗可以明显改善患者脂代谢情况,可以有效降低患者血清磷、钙磷乘积等指标,联合用药不良反应发生率更低。

Objective To evaluate the efficacy of sevelamer and calcium acetate tablets in the treatment of hyperphosphatemia in maintenance hemodialysis patients.Methods The maintenance hemodialysis patients with hyperphosphatemia admitted to the hospital from April 2017 to April 2019 were screened.100 patients were randomly selected as the subjects of this study.The blind selection method was randomly divided into two groups,50 cases in each group.The control group was treated with calcium acetate tablets,and the study group was treated with sevelamer combined with calcium acetate tablets.After 15 d of treatment,the two groups of patients were observed before and after the treatment of blood lipids,blood phosphorus,calcium and phosphorus product,serum parathyroid hormone,alkaline phosphatase and adverse reactions.Results After treatment,the study group had low density lipoprotein(1.67±0.25)mmol/L,high density lipoprotein(1.09±0.17)mmol/L,serum phosphorus(1.76±0.32)mmol/L,serum calcium(2.19±0.19)mmol/L,calcium and calcium phosphorus product(3.41±0.53)mmol/L,the serum spring parathyroid hormone(3.91±0.62)pmol/L was better than the control group(1.88±0.23)mmol/L,(1.18±0.14)mmol/L,(2.05±0.29)mmol/L,(2.28±0.20)mmol/L,(3.59±0.55)mmol/L,(4.53±0.67)pmol/L,the difference was statistically significant(t=4.371,2.890,4.748,2.307,3.762,4.803,P<0.05);during the treatment period,the incidence of adverse reactions in the study group was 4.00%lower than that in the control group 18.00%,and the difference was statistically significant(χ^(2)=5.005,P<0.05).Conclusion The combined treatment of calcium acetate tablets and sevelamer for maintenance hemodialysis patients with hyperphosphatemia can significantly improve the patient’s lipid metabolism,effectively reduce the patient’s blood phosphorus,calcium and calcium phosphorus product and other indicators,and the incidence of adverse reactions to the combined medication is lower.