碳酸镧治疗伴高钙磷乘积血液透析患者高磷血症的效果观察

Efficacy of Lanthanum carbonate in maintenance hemodialysis patients with hyperphosphatemia and high calcium times phosphate product

目的 观察碳酸镧治疗伴高钙磷乘积血液透析患者高磷血症的疗效及不良反应.方法 选择血磷≥2.0mmol/L,钙磷乘积≥4.52 mmol2/L2的维持性血液透析(MHD)患者23例,给予碳酸镧餐中嚼服,疗程4周,分别于治疗前、后检测血常规(Hb)、血白蛋白(ALB)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、血钙(Ca)、血磷(P)、计算钙磷乘积(Ca×P)及甲状旁腺激素(iPTH),评价疗效,并观察不良反应.结果 与治疗前比较,血P、钙磷乘积水平明显下降[(2.48±0.55) mmol/L与(1.83±0.37) mmol/L、(5.21±1.35) mmol2/L2比(4.10±0.96) mmol2/L2],差异均有统计学意义(t值分别为2.742、2.936,P均＜0.05);血Ca、iPTH、Hb、ALB水平治疗前后均无明显变化,差异均无统计学意义(P均＞0.05),ALT、AST水平在正常范围内.5例出现可耐受的腹部不适.结论 碳酸镧能在短期内明显降低MHD患者血磷及钙磷乘积水平,不良反应轻,尤其对伴高钙磷乘积的高磷血症患者,是较为理想的磷结合剂.

Objective To assess the efficacy and adverse reaction of Lanthanum carbonate in patients with hyperphosphatemia and high calcium times phosphate product receiving maintenance hemodialysis.Methods Twenty-three hemodialysis patients with serum phosphate ≥ 2.0 mmol/L and/or the serum calcium times phosphate product ≥ 4.52 mmol2/L2 were prescribed Lanthanum carbonate chewed with meals for 4 weeks.Blood (Hb), serum albumin (ALB), alanine amino shift enzyme (ALT), aspartic acid transaminase (AST) ,calcium(CA), phosphorus (P) calculated the product of calcium and phosphorus (Ca×P) and intact parathyroid hormone (iPTH) level were checked before and after Lantharum carbonate therapy.The adverse reactions were recorded concomitantly.Results Serum phosphate and the serum calcium time phosphate product significantly decreased after 1 month Lanthanum carbonate therapy((2.48±0.55) mmol/L vs.(1.83 ±0.37) mmol/L, (5.21 ± 1.35) mmol2/L2 vs.(4.10±0.96) mmol2/L2;t =2.742,2.936;P＜0.05).Serum calcium, iPTH level and blood cells count remained no change(P＞0.05), while serum ALT, AST concentration within normal range.Five patients complained affordable abdomen discomfort or upset.Conclusion Lantharum carbonate show to effectively and quickly control serum phosphorus levels and calcium time phosphate product in hemodialysis patients without inducing changes in serum calcium and should be considered an ideal phosphate binder.