血液透析患者高磷血症的治疗

The treatment of hyperphosphatemia in hemodialysis patients.

目的 比较醋酸钙和碳酸钙治疗血液透析患者高磷血症的疗效及安全性。方法 采用醋酸钙或碳酸钙治疗血液透析并高磷血症患者8周,共60例。测定服用药物治疗前后血钙、血磷及甲状旁腺素并观察不良反应。结果 醋酸钙和碳酸钙降磷作用分别于治疗2周和4周后出现,治疗8周时两者的降血磷作用分别为醋酸钙组由(2.32±0.68)mmol/IJ降为(1.72±0.59)mmol/L(P<0.01),碳酸钙组由(2.29±0.71)mmol/L降为(1.75±0.70)mmol/L(P<0.05),醋酸钙组和碳酸钙组消化道反应发生率分别为23％和27％(P>0.05);高钙血症发生率分别为7％和17％(P<0.01);两组血PTH于治疗前后无显著变化。结论 醋酸钙与碳酸钙相比具有相同的降磷效果和胃肠道副作用,但醋酸钙起效较快,导致高钙血症发生率低,是治疗血液透析患者高磷血症有效、安全的药物。

Objective To compare the effect and safety on treatment of hyperphosphatemia in hemodialysis patients with calcium acetate and calcium carbonate. Methods Sixty hemodialysis patients with hyperphosphatemia were treated with either calcium acetate or calcium carbonate for 8 weeks. The serum calcium, serum phosphate and parathyriod hormone (PTH) were detected before and after treatment and side effects of the treatment were recorded. Results The significant dropness of phosphorus levels were observed after 2 weeks treatment with calcium acetate and 4 weeks with calcium carbonate. The phosphorus levels significantly dropped in both groups after 8 weeks treatment [(2.32±0.68)mmol/L vs (1.72±0.59)mmol/L, P<0.01 and (2.29±0.71)mmol/L vs (1.75±0.70)mmol/ L, P < 0.05, for calcium acetate and calcium carbonate, respectively ]. The side effect rate of gastrointestinal symptoms in both calcium acetate group and calcium carbonate group were 23% and 27%(P>0.05), respectively, and hypercalcemia were 7% and 17% ( P < 0.01) , respectively. There were no significant change in both groups in the PTH level. Conclusion Calcium acetate has the same effect on declining of phosphorus level and happeming of gastrointestinal symptoms with calcium carbonate in treatment of hyperphosphatemia in hemodialysis patients. But the effect of phosphorus level dropness in calcium acetate group is faster than that in calcium carbonate group. And the hypercalcemia caused by calcium acetate treatment is lower than that by calcium carbonate treatment significantly. So, calcium acetate is an effective and safe salt for treating hyperphosphatemia in hemodialysis patients.