维持性血液透析患者服用不同钙磷调节药物的比较研究

Comparative Study of Different Calcium and Phosphorus Modulators in Patients with Maintenance Hemodialysis

目的探讨帕立骨化醇及骨化三醇对维持性血液透析(MHD)患者血清钙磷代谢的内分泌调节、脂代谢及肾功能的影响。方法选取2019年1—12月四川大学华西医院收治的合并高磷血症的MHD患者79例为研究对象,采用随机数字表法分为帕立骨化醇组(n=38)和骨化三醇组(n=41)。治疗前及治疗1个月后,比较两组血磷、血钙、甲状旁腺激素(PTH)、钙磷乘积值、高敏C反应蛋白(hs-CRP)及低密度脂蛋白胆固醇(LDL-C)、β2微球蛋白(β2-MG)、胱抑素C(Cys-C)水平,并记录两组用药不良反应。结果治疗1个月后,两组患者血磷水平与治疗前及两组间比较,差异无统计学意义(P>0.05);骨化三醇组血钙、钙磷乘积值水平高于治疗前及同期帕立骨化醇组(P<0.05);帕立骨化醇组PTH水平低于治疗前及骨化三醇组(P<0.05)。治疗1个月后,帕立骨化醇组hs-CRP水平低于治疗前及同期骨化三醇组(P<0.05)。治疗1个月后,两组β2-MG、Cys-C水平低于治疗前(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论帕立骨化醇对MHD患者PTH水平的降低效果优于骨化三醇,且在控制患者炎症反应方面有积极作用。

Objective To investigate the effects of paricalcitol and calcitriol on endocrine regulation of serum calcium-phosphorus metabolism,lipid metabolism and renal function in patients with maintenance hemodialysis(MHD).Methods A total of 79 MHD patients with hyperphosphatemia admitted to West China Hospital of Sichuan University between January 2019 and December 2019 were selected and divided into paricalcitol group(n=38)and calcitriol group(n=41)according to random number table method.Before treatment and after 1 month of treatment,the levels of blood phosphorus,blood calcium,parathyroid hormone(PTH),calcium-phosphorus product,high-sensitivity C-reactive protein(hs-CRP),low-density lipoprotein cholesterol(LDL-C),β2 microglobulin(β2-MG)and Cystatin C(Cys-C)were compared between the two groups.The adverse drug reactions in both groups were recorded.Results After 1 month of treatment,there was no significant difference in blood phosphorus level in the two groups compared with that before treatment,and there was no significant difference between the two groups(P>0.05).The levels of blood calcium and calcium-phosphorus product in calcitriol group were significantly higher than those before treatment and those in paricalcitol group during the same period,and the level of PTH in paricalcitol group was significantly lower than that before treatment and that in calcitriol group during the same period(P<0.05).After 1 month of treatment,the hs-CRP level in paricalcitol group was significantly lower than that before treatment and that in calcitriol group during the same period(P<0.05).After 1 month of treatment,the levels ofβ2-MG and Cys-C in the two groups were significantly lower than those before treatment(P<0.05).There were no significant differences in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Paricalcitol is better than calcitriol in reducing the PTH level in MHD patients,and it also has a positive effect on the control of inflammatory response in patients.