碳酸司维拉姆与醋酸钙治疗维持性血液透析伴高磷血症患者的效果比较

Comparison of effects of Sevelamer carbonate and Calcium acetate in treatment of maintenance hemodialysis patients with hyperphosphatemia

目的:比较碳酸司维拉姆与醋酸钙治疗维持性血液透析伴高磷血症患者的效果。方法:回顾性分析2020年1月至2022年10月该院收治的92例维持性血液透析伴高磷血症患者的临床资料,根据治疗方式的不同将其分为对照组和观察组各46例。对照组口服醋酸钙片治疗,观察组口服碳酸司维拉姆片治疗,比较两组治疗前后血磷、血钙、全段甲状旁腺激素(iPTH)水平,皮肤瘙痒评分,以及不良反应发生率。结果:治疗后,两组血磷水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);治疗后,对照组血钙水平高于治疗前和观察组,差异均有统计学意义(P<0.05),观察组血钙水平与治疗前比较,差异无统计学意义(P>0.05);治疗后,两组iPTH水平均低于治疗前,但组间比较差异无统计学意义(P>0.05);治疗后,两组皮肤瘙痒评分均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论:碳酸司维拉姆治疗维持性血液透析伴高磷血症患者效果优于醋酸钙,可降低血磷水平,减轻皮肤瘙痒症状,改善甲状旁腺功能,降低不良反应发生率,且不会升高血钙水平,安全性更好。

Objective:To compare effects of Sevelamer carbonate and Calcium acetate in treatment of maintenance hemodialysis patients with hyperphosphatemia.Methods:The data of 92 maintenance hemodialysis patients with hyperphosphatemia admitted to this hospital from January 2020 to October 2022 were retrospectively analyzed.According to different treatment methods,they were divided into control group and observation group,46 cases in each group.The control group was treated with Calcium acetate tablets orally,while the observation group was treated with Sevelamer carbonate tablets orally.The levels of serum phosphorus,serum calcium,serum intact parathyroid hormone(iPTH),skin pruritus score,and the incidence of adverse reactions were compared between the two groups before and after the treatment.Results:After the treatment,the blood phosphorus levels of the two groups were lower than those before the treatment,that in the observation group was lower than that in the control group,and the differences were statistically significant(P<0.05).After the treatment,the blood calcium level of the control group was significantly higher than that before the treatment and the observation group,and the differences were statistically significant(P<0.05).There was no significant difference in the serum calcium level in the observation group before and after the treatment(P>0.05).After the treatment,the levels of iPTH in the two groups were lower than those before the treatment,however,there was no significant difference in the iPTH level between the two groups after the treatment(P>0.05).After the treatment,the scores of skin pruritus in both groups were lower than those before the treatment,the score of skin pruritus in the observation group was lower than that in the control group,and the differences were statistically significant(P<0.05).The incidence of adverse reactions in the observation group was lower than that in the control group,the difference was statistically significant(P<0.05).Conclusions:Sevelamer carbonate in the treatment of the maintenance hemodialysis patients with hyperphosphatemia is superior to Calcium acetate.It can reduce the levels of blood phosphorus,relieve the skin pruritus symptoms,and improve the parathyroid gland function without increasing the level of blood calcium.Further,it can reduce the incidence of adverse reactions and has better safety.