碳酸司维拉姆联合血液透析和血液灌流治疗CKD-MBD的疗效及对患者微炎症状态和钙磷代谢的影响

Efficacy of sevelamer carbonate combined with hemodialysis and hemoperfusion in the treatment of chronic kidney disease-mineral and bone disorder and its effect on micro-inflammation and calcium and phosphorus metabolism

目的探究碳酸司维拉姆联合血液透析和血液灌流治疗慢性肾脏病矿物质和骨代谢异常(CKD-MBD)的疗效及对患者微炎症状态和钙磷代谢的影响。方法回顾性分析广东省农垦中心医院血液净化科2018年2月至2020年2月治疗的82例CKD-MBD患者的临床资料。按照治疗方法不同分组,其中41例采用血液透析和血液灌流治疗者纳入对照组,41例采用碳酸司维拉姆联合血液透析和血液灌流治疗者纳入研究组,比较两组患者的治疗效果,以及治疗前、治疗结束随访2个月后的C反应蛋白(CRP)、血钙、血磷、血清甲状旁腺激素(PTH)和尿素氮(BUN)水平。结果研究组患者的临床治疗总有效率为97.56%,高于对照组的75.61%,差异有统计学意义(P<0.05);治疗前,两组患者的血钙、血磷、CRP、PTH、BUN水平比较差异均无统计学意义(P>0.05);治疗后,两组患者的血钙水平明显升高,CRP、PTH、BUN水平明显降低,差异均有统计学意义(P<0.05),但治疗后,研究组与对照组患者的血钙水平分别为(2.55±0.48)mmol/L、(2.51±0.43)mmol/L,差异无统计学意义(P>0.05),而研究组患者的CRP、PTH、BUN水平分别为(6.19±1.98)mg/L、(42.55±5.12)pg/mL、(13.98±3.17)mmol/L,明显低于对照组的(13.93±3.01)mg/L、(82.91±6.03)pg/mL、(18.38±4.01)mmol/L,差异均有统计学意义(P<0.05);治疗后,研究组患者的血磷水平为(1.72±0.49)mmol/L,明显低于对照组的(2.38±0.52)mmol/L,差异有统计学意义(P<0.05);研究组患者的不良情况发生率为4.78%,明显低于对照组的21.95%,差异有统计学意义(P<0.05)。结论碳酸司维拉姆联合血液透析和血液灌流治疗CKD-MBD能改善患者的微炎症状态和高血钙、磷代谢症状,临床治疗效果好。

Objective To explore the effect of sevelamer carbonate combined with hemodialysis and hemoperfusion in the treatment of chronic kidney disease-mineral and bone disorder(CKD-MBD)and its influence on the micro-inflammatory state and calcium and phosphorus metabolism.Methods The clinical data of 82 patients with CKD-MBD treated in the Department of Blood Purification,Guangdong Agricultural Reclamation Central Hospital from February 2018 to February 2020 were retrospectively analyzed.According to the different treatment methods,41 patients undergoing hemodialysis and hemoperfusion were included in the control group,and 41 patients treated with sevelamer carbonate combined with hemodialysis and hemoperfusion were included in the study group.The treatment effect,C-reactive protein(CRP),blood calcium,blood phosphorus,serum parathyroid hormone(PTH),and urea nitrogen(BUN)levels were compared between the two groups.The levels of C-reactive protein(CRP),blood calcium,blood phosphorus,serum parathyroid hormone(PTH),and urea nitrogen(BUN)were measured before and 2 months after treatment.Results The total effective rate of the study group was 97.56%,which was higher than 75.61%of the control group(P<0.05);Before treatment,there was no significant difference in the levels of serum calcium,phosphorus,CRP,PTH,and BUN between the two groups(P>0.05);after treatment,the levels of serum calcium in the two groups were significantly increased,while the levels of CRP,PTH,and BUN were significantly decreased(P<0.05);after treatment,the level of serum calcium was(2.55±0.48)mmol/L in the study group versus(2.51±0.43)mmol/L in the control group,with no significant difference between the two groups(P>0.05),and the levels of CRP,PTH,and BUN in the study group were(6.19±1.98)mg/L,(42.55±5.12)pg/mL,(13.98±3.17)mmol/L,which were significantly lower than(13.93±3.01)mg/L,(82.91±6.03)pg/mL,(18.38±4.01)mmol/L in the control group(P<0.05).After treatment,the blood phosphorus level in the study group was(1.72±0.49)mmol/L,significantly lower than(2.38±0.52)mmol/L of the control group(P<0.05).The incidence of adverse events of the study group was 4.78%,significantly lower than 21.95%of the control group(P<0.05).Conclusion Sevelamer carbonate combined with hemodialysis and hemoperfusion in the treatment of CKD-MBD can improve the micro-inflammatory state and the symptoms of high blood calcium and phosphorus metabolism.