碳酸司维拉姆对老年终末期肾病合并高磷酸血症患者TGF-β1/Smad通路的影响

Effect of Sevelamer Carbonate on TGF-β1/Smad Pathway in Elderly Patients with End-stage Renal Disease and Hyperphosphatemia

【目的】探讨碳酸司维拉姆对老年终末期肾病(ESRD)合并高磷酸血症患者转化生长因子β1(TGF-β1)/丝/苏氨酸激酶受体(Smad)通路的影响。【方法】82例老年ESRD合并高磷酸血症患者,随机分为两组,每组41例。对照组采用碳酸钙治疗,观察组采用碳酸司维拉姆治疗。比较两组治疗前后血清全段甲状旁腺激素(iPTH)、血钙、血磷、血脂[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、肾功能[血肌酐(Scr)、尿素氮(BUN)]、TGF-β1、Smad 7水平及两组不良反应发生率。【结果】两组治疗后血钙、血磷、TG、TC、LDL-C、Scr、BUN水平较治疗前降低(P<0.05),且观察组治疗后上述指标的水平低于对照组(P<0.05)。两组治疗后iPTH、HDL-C水平与治疗前及两组之间比较,差异无统计学意义(P>0.05)。两组治疗后TGF-β1水平较治疗前降低(P<0.05),Smad 7水平较治疗前升高(P<0.05);观察组治疗后TGF-β1水平低于对照组(P<0.05),Smad 7高于对照组(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】碳酸司维拉姆治疗老年ESRD合并高磷酸血症患者的疗效显著,可通过抑制TGF-β1/Smad信号通路表达,降低血钙、血磷及血脂水平,且用药安全,值得推广。

【Objective】To explore the effect of sevelamer carbonate on the transforming growth factorβ1(TGF-β1)/Smad pathway in elderly patients with end-stage renal disease(ESRD)complicated with hyperphosphatemia.【Methods】Eighty-two elderly patients with ESRD and hyperphosphatemia were randomly divided into two groups,with 41 cases in each group.The control group was treated with calcium carbonate,while the observation group was treated with sevelamer carbonate.The levels of intact parathyroid hormone(iPTH),serum calcium,serum phosphorus,lipid[total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)],renal function[serum creatinine(Scr),blood urea nitrogen(BUN)]and TGF-β1,Smad,and the occurrence rate of adverse reactions were compared between the two groups before and after treatment.【Results】After treatment,the levels of serum calcium,serum phosphorus,TG,TC,LDL-C,Scr,and BUN in both groups were lower than those before treatment(P<0.05),and these indicators in the observation group were lower than those in the control group(P<0.05).There were no significant differences in the levels of iPTH,HDL-C before and after treatment between the two groups(P>0.05).The levels of TGF-β1 were lower and the levels of Smad 7 were higher after treatment in both groups(P<0.05).The level of TGF-β1 in the observation group was lower than that in the control group,and the level of Smad 7 was higher than that in the control group(P<0.05).There was no significant difference in the occurrence rate of adverse reactions between the two groups(P>0.05).【Conclusion】Sevelamer carbonate has a significant therapeutic effect on elderly patients with ESRD complicated with hyperphosphatemia.It can inhibit the expression of the TGF-β1/Smad signaling pathway,reduce the levels of blood calcium,phosphorus,and lipids,and is safe for medication use,hence it is worth promoting.