碳酸司维拉姆联合血液透析对尿毒症后肾性骨病患者的影响

The Effect of Combination of Sevelamer Carbonate and Hemodialysis on Patients with Renal Osteodystrophy after Uremia

目的:观察并探讨尿毒症后肾性骨病患者临床治疗过程中血液透析与碳酸司维拉姆联合应用效果及对成纤维细胞生长因子23(FGF-23)、骨形态发生蛋白7(BMP-7)的影响。方法:于2022年1月—2023年1月广州市第一人民医院南沙医院接收72例尿毒症后肾性骨病患者,运用随机数字表法给进行分组,对照组(n=36)、联合组(n=36)。其中对照组进行血液透析治疗,联合组则在血液透析基础上加用碳酸司维拉姆。比较两组临床治疗效果、骨碱性磷酸酶(BAP)、FGF-23、BMP-7、甲状旁腺激素(PTH)、C反应蛋白(CRP)、β_(2)微球蛋白(β_(2)-MG)、骨钙素(OCN)、不良反应。结果:联合组临床总有效率为91.67%,高于对照组的72.22%,差异有统计学意义(P<0.05)。治疗前,两组BAP、FGF-23、BMP-7、PTH、CRP、β_(2)-MG、OCN比较,差异均无统计学意义(P>0.05);治疗后,联合组BMP-7高于对照组,BAP、FGF-23、PTH、CRP、β_(2)-MG、OCN均低于对照组,差异均有统计学意义(P<0.05);联合组胃胀气、腹泻、反胃、干呕等不良反应发生率为11.11%与对照组的16.67%比较,差异无统计学意义(P>0.05)。结论:尿毒症后肾性骨病患者在血液透析期间联合碳酸司维拉姆治疗具有确切效果,可调节骨代谢,改善肾功能,减轻微炎症反应,安全性高,患者耐受。

Objective:To observe and explore the effect of hemodialysis combined with Sevelamer Carbonate in the clinical treatment of patients with renal osteodystrophy after uremia and the effect on on fibroblast growth factor 23(FGF-23)and bone morphogenetic protein 7(BMP-7).Method:From January 2022 to January 2023,Nansha Hospital of Guangzhou First People's Hospital received 72 patients with renal osteodystrophy after uremia were selected,and divided to the control group(n=36)and the combined group(n=36)by random number table method.The control group received hemodialysis treatment,and the combined group was treated with Sevelamer Carbonate on the basis of hemodialysis.Clinical efficacy,bone alkaline phosphatase(BAP),FGF-23,BMP-7,parathyroid hormone(PTH),C reactive protein(CRP),β_(2) microglobulin(β_(2)-MG),osteocalcin(OCN)and adverse reactions of two groups were compared.Result:The total clinical efficiency rate of combination group was 91.67%,higher than 72.22%of control group,the difference was statistically significant(P<0.05).Before treatment,there were no differences in the BAP,FGF-23,BMP-7,PTH,CRP,β_(2)-MG and OCN between the two groups(P>0.05);after treatment,BMP-7 in the combined group was higher than that in the control group,while BAP,FGF-23,PTH,CRP,β_(2)-MG and OCN were lower than those in the control group(P<0.05).The incidence of adverse reaction on bloating,diarrhea,nausea and retching was 11.11%in the combined group and 16.67%in the control group,the difference was not statistically significant(P>0.05).Conclusion:The combination of Sevelamer Carbonate in patients with renal osteodystrophy after uremia during hemodialysis has a definite effect,which can regulate bone metabolism,improve renal function,reduce micro-inflammatory reaction,high safety,patient tolerance.