低钙透析液对维持性血液透析患者颈动脉内膜中层厚度和心脏功能的影响

Effect of low calcium dialysate on the carotid intima-media thickness and cardiac function in maintenance hemodialysis patients

目的观察低钙透析液(LCD)1.25 mmol/L对维持性血液透析(MHD)患者心脏功能结构和颈动脉内-中膜厚度(CIMT)的影响。方法本研究采用随机、双盲、对照的临床试验设计。选择非低钙血症、甲状旁腺激素(PTH)<300 pg/ml、2015年2至7月在广州市红十字会医院血液透析中心血液透析的34例MHD患者,所有患者入组前均使用标准钙1.5 mmol/L透析。入组后试验组改用低钙1.25 mmol/L透析液,余治疗方案不变,对照组仍予以标准钙1.5 mmol/L透析。治疗前后行血生化检查。采用彩色多普勒超声诊断仪检测CIMT、左心室射血分数(LVEF),测量左心室舒张早期和舒张晚期最大血流速度及两者比值(E/A),并根据公式计算心脏指数(CI)。结果所有入组患者均完成研究。在使用LCD 6个月后,患者血清钙值和钙磷乘积[(2.17±0.46)mmol^2/L^2,(50.67±7.35)mmol^2/L^2]与使用标准钙透析液[(2.58±0.57)mmol^2/L^2、(57.35±9.26)mmol^2/L^2]相比明显下降(P<0.05),而其他的血生化指标的变化无统计学差异。LCD患者CIMT[(1.02±0.26)mm]较标准钙透析液组[(1.19±0.21)mm]相比明显下降(P<0.05),E/A比值水平明显上升(1.05±0.21vs.0.92±0.14,P<0.05),而左心室射血分数及心脏指数变化无统计学差异(P>0.05)。结论 LCD可能改善血液透析患者动脉粥样硬化和动脉顺应性的下降,促进心脏舒张功能改善,推测其作用可能与纠正钙磷代谢紊乱有关。

Objective To observe the effect of low calcium dialysate(LCD, 1.25 mmol/L) on the cardiac function and carotid intima-media thickness(CIMT) in maintenance hemodialysis(MHD) patients. Methods Randomized, double-blind, sham-controlled design was used. 34 MHD patients were randomly divided into LCD group and SCD(standard calcium dialysate, 1.5 mmol/L) group. All of them were dialysed by using the standard calcium 1.5 mmol/L before the experiment. Standard calcium dialysate solution was changed to lower calcium dialysate solution in LCD group for the course of 6 months. Before and after the experiment, the serum biochemical indicators were examined and Color Doppler ultrasonography was used to detect CIMT and cardiac function. Results All the patients were followed up. After treatment, the serum calcium and calcium phosphorus product of LCD group [(2.17±0.46)mmol^2/L^2,(50.67±7.35)mmol^2/L^2] decreased obviously compared with the level of SCD group [(2.58±0.57)mmol^2/L^2,(57.35±9.26)mmol^2/L^2](P<0.05). The CIMT of LCD group [(1.02±0.26)mm] decreased significantly compared with the SCD group [(1.19±0.21)mm](P<0.05). The E/A ratio of LCD group increased significantly(1.05±0.21 vs. 0.92±0.14, P<0.05), and there was no statistical difference in left ventricular ejection fraction and cardiac output index between LCD group and SCD group(P>0.05). Conclusion LCD can improve atherosclerosis and compliance descent of artery of MHD patients, promote the cardiac diastolic function. These effect may be related to the decreasing serum calcium level.