低钙腹膜透析液对慢性肾功能衰竭患者血清钙磷代谢及肾功能的影响

Effects of low calcium dialysate on serum calcium-phosphorus metabolism and renal function in patients with chronic renal failure

目的探讨低钙腹膜透析液(LCD)对慢性肾功能衰竭(CRF)患者血清钙磷代谢、肾损伤分子-1(KIM-1)、白细胞介素-18(IL-18)及肾功能的影响。方法回顾性分析2014年1月至2017年1月驻马店市中心医院收治的100例CRF患者的临床资料,根据钙离子浓度分为标准钙腹膜透析液(SCD)组(钙离子浓度1.75 mmol/L,48例)和LCD组(钙离子浓度1.25 mmol/L,52例)。比较两组血钙、血磷、钙磷乘积、全段甲状旁腺激素(iPTH)、iPTH达标率、KIM-1、IL-18、肾功能[血尿素氮(BUN)、肌酐(Scr)、尿酸(UA)、24 h尿蛋白、白蛋白(ALB)]及3年生存率。结果治疗后,LCD组血钙、血磷及钙磷乘积水平分别为(2.10±0.85)mmol/L、(1.40±0.52)mmol/L、(40.81±7.63)mg^(2)/dl^(2),低于SCD组的(2.54±1.17)mmol/L、(1.72±0.92)mmol/L、(50.12±9.67)mg^(2)/dl^(2)(P<0.05)。治疗前后,两组iPTH水平、iPTH达标率、KIM-1、IL-18、BUN、Scr、UA、24 h尿蛋白、ALB水平比较差异未见统计学意义(P>0.05)。两组1、2年生存率比较差异未见统计学意义(P>0.05),LCD组3年生存率(94.23%,49/52)高于SCD组(81.25%,39/48),P<0.05。结论LCD可改善CRF患者的钙磷代谢,维持血清PTH水平及甲状旁腺功能稳定,提高生存质量。

Objective To investigate the effects of low calcium dialysate(LCD)on serum calcium-phosphorus metabolism,kidney injury molecule-1(KIM-1),interleukin-18(IL-18)and renal function in patients with chronic renal failure(CRF).Methods The clinical data of 100 patients with CRF who were admitted and treated in Zhumadian Central Hospital from January 2014 to January 2017 were retrospectively analyzed.According to the concentrations of calcium ion,patients were divided into the standard calcium dialysate(SCD)group(calcium ion concentration of 1.75 mmol/L,n=48)and LCD group(calcium ion concentration of 1.25 mmol/L,n=52).Blood calcium,blood phosphorus,calcium-phosphorus product,intact parathyroid hormone(iPTH),standard-reaching rate of iPTH,KIM-1,IL-18,renal function assessed by blood urea nitrogen(BUN),serum creatinine(Scr),and uric acid(UA),24 h urinary protein,albumin(ALB),and 3-year survival rate were compared between the two groups.Results After treatment,blood calcium,blood phosphorus and calcium-phosphorus product in the LCD group were(2.10±0.85)mmol/L,(1.40±0.52)mmol/L,and(40.81±7.63)mg^(2)/dl^(2),respectively,lower than the(2.54±1.17)mmol/L,(1.72±0.92)mmol/L and(50.12±9.67)mg^(2)/dl^(2) in the SCD group(P<0.05).The differences of iPTH level,standard-reaching rate of iPTH,KIM-1,IL-18,BUN,Scr,UA,24 h urine protein and ALB levels between the two groups were not statistically significant before and after treatment(P>0.05).There was no significant difference in 1-year and 2-year survival rates between the two groups(P>0.05).The 3-year survival rate of the LCD group(94.23%,49/52)was higher than that of the SCD group(81.25%,39/48),P<0.05.Conclusions LCD can improve calcium and phosphorus metabolism in patients with CRF,maintain serum PTH levels and stable parathyroid function,and improve quality of life of patients.