碳酸镧联合帕立骨化醇在维持性血液透析患者左心室肥厚及冠状动脉钙化中的疗效观察

Efficacy of Lanthanum Carbonate Combined with Paricalcitol on Left Ventric⁃ular Hypertrophy in Left Ventricular Hypertrophy and Coronary Artery Calci⁃fication in Patients with Maintenance Hemodialysis

目的 探讨碳酸镧(lanthanum carbonate,LC)联合帕立骨化醇在维持性血液透析(maintenance hemodialysis,MHD)患者左心室肥厚(left ventricular hypertrophy,LVH)及冠状动脉钙化中的疗效。方法 选择2020年6月至2021年6月恩施州中心医院行MHD治疗的96例患者,按照随机数表法分为观察组和对照组各48例。对照组予醋酸钙片,观察组予LC联合帕立骨化醇治疗,均连续治疗12周。比较2组患者的临床疗效、血钙(calcium,Ca)、血磷(phosphorus,P)、全段甲状旁腺素(intact parathyroid hormone,i PTH)、左心室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)、左心室收缩末期内径(left ventricular end-systolic diameter,LVESD)、左心室后壁厚度(left ventricular posterior wall thickness,LVPWT)、室间隔厚度(interventricular septal thickness,IVST)、左心室心肌质量指数(left ventricular mass index,LVMI)、冠状动脉钙化积分(coronary artery calcification score,CACS)以及不良反应发生情况。结果 观察组患者临床疗效高于对照组,差异有统计学意义(89.58%vs. 70.83%,P=0.021)。治疗后,观察组患者的血Ca、血P、iPTH浓度低于对照组,差异有统计学意义[血Ca:(2.28±0.38)mmol/L vs.(2.53±0.45)mmol/L,P=0.007;血P:(1.71±0.38)mmol/L vs.(1.97±0.46)mmol/L,P=0.003;iPTH:(219.45±63.84)pg/mL vs.(261.51±68.64)pg/mL,P=0.003]。治疗后,观察组患者的LVMI、LVPWT、IVST、LVEDD、LVESD低于对照组,LVEF高于对照组,差异有统计学意义[LVMI:(137.14±34.26)g/m2vs.(153.94±36.55)g/m2,P=0.022;LVPWT:(12.01±0.84)mm vs.(12.57±0.92)mm,P=0.002;IVST:(12.32±0.82)mm vs.(12.69±0.89)mm,P=0.037;LVEDD:(46.14±4.22)mL vs.(48.66±4.70)m L,P=0.007;LVESD:(28.96±1.81)m L vs.(30.04±2.07)mL,P=0.008;LVEF:48.10%±5.52%vs. 44.04%±5.16%,P=0.000]。治疗后,观察组患者的CACS评分低于对照组,差异有统计学意义[(231.64±28.42)分vs.(288.97±30.77)分,P=0.000)]。两组患者总不良反应发生率比较,差异无统计学意义(8.33%vs. 6.25%,P=0.695)。结论 LC联合帕立骨化醇可有助于减轻MHD患者血管钙化及LVH情况,且安全性较佳。

Objectives To investigate the efficacy of lanthanum carbonate(LC)combined with paricalcitol in left ventricular hypertrophy(LVH)and coronary artery calcification in patients with maintenance hemodialysis(MHD).Methods From June 2020 to June 2021,96 patients treated with MHD in Central Hospital of Enshi were divided into observation group and control group with 48 cases in each group,according to random number table method.Control group was treated with calcium acetate tablets,and observation group was treated with LC combined with paricalcitol for 12 weeks.The clinical efficacy,blood calcium(Ca),blood phosphorus(P),intact parathyroid hormone(iPTH),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left ventricular ejection fraction(LVEF),left ventricular posterior wall thickness(LVPWT),interventricular septal thickness(IVST),left ventricular mass index(LVMI),coronary artery calcification score(CACS),and the occurrence of adverse reactions were compared between the two groups.Results The clinical effect of observation group was significantly higher than that of control group(89.58%vs.70.83%,P=0.021).After treatment,the blood concentrations of Ca,P and iPTH in observation group were lower than those in control group[blood Ca:(2.28±0.38)mmol/L vs.(2.53±0.45)mmol/L,P=0.007;blood P:(1.71±0.38)mmol/L vs.(1.97±0.46)mmol/L,P=0.003;iPTH:(219.45±63.84)pg/mL vs.(261.51±68.64)pg/mL,P=0.003].After treatment,LVMI,LVPWT,IVST,LVEDD and LVESD in observation group were significantly lower than those in control group,and LVEF was significantly higher than that in control group[LVMI:(137.14±34.26)g/m2 vs.(153.94±36.55)g/m2,P=0.022;LVPWT:(12.01±0.84)mm vs.(12.57±0.92)mm,P=0.002;IVST:(12.32±0.82)mm vs.(12.69±0.89)mm,P=0.037;LVEDD:(46.14±4.22)mL vs.(48.66±4.70)mL,P=0.007;LVESD:(28.96±1.81)mL vs.(30.04±2.07)mL,P=0.008;LVEF:48.10%±5.52%vs.44.04%±5.16%,P=0.000).After treatment,CACS scores in observation group were obviously lower than that in control group[(231.64±28.42)points vs.(288.97±30.77)points,P=0.000].There was no significant difference in the incidence of total adverse reactions between the two groups(8.33%vs.6.25%,P=0.695).Conclusions LC combined with paricalcitol can alleviate vascular calcification and LVH in MHD patients with better safety.