摘要
目的 观察透析钙浓度对维持性血液透析患者血钙、磷及甲状旁腺激素（iPTH）的影响.方法 将北京安贞医院应用Ca^2＋浓度1.50 mmol/L透析液进行血液透析治疗的患者中血钙超过2.10 mmol/L的患者改用Ca^2＋＋1.25 mmol/L透析液,共107例,脱落6例.将患者应用Ca^2＋浓度1.50 mmol/L透析液时及应用Ca^2＋浓度1.25 mmol/L透析液6个月后血钙、磷和iPTH的化验数值进行统计分析,并根据血iPTH水平进行分组分析.结果 110例应用Ca^2＋浓度1.25 mmol/L透析液后较应用Ca^2＋浓度1.50 mmol/L透析液血钙升高[（2.39±0.22） mmol/L比（2.32±0.29） mmol/L]、血磷降低[（2.04±0.62） mmol/L比（2.19 ±0.71） mmol/L] （P ＜0.05）.血iPTH＜ 150 ng/L组20例,iPTH 150～300 ng/L组23例,301 ～600 ng/L组37例,iPTH＞ 600 ng/L组21例.血iPTH＜ 150 ng/L组应用Ca^2＋浓度1.25 mmol/L透析液进行血液透析6个月后血iPTH均值＞150 ng/L,差异有统计学意义（P＜0.05）;iPTH150～300 ng/L组应用Ca^2＋浓度1.25 mmol/L后较应用Ca^2＋浓度1.50 mmol/L透析液血磷下降[（1.87±0.55） mmol/L比（2.09 ± 0.70） mmol/L],但差异无统计学意义（P＞0.05）;iPTH 301 ～ 600 ng/L组应用Ca^2＋浓度1.25 mmol/L后较应用Ca^2＋浓度1.50 mmol/L透析液iPTH和血磷略下降[（410±330） ng/L比（443 ± 92） ng/L,（2.03±0.55） mmol/L比（2.11 ±0.69） mmol/L],差异无统计学意义（P＞0.05）,血钙升高差异有统计学意义[（2.38±0.21） mmol/L比（2.26 ±0.22） mmol/L] （P ＜0.05）.结论 应用Ca^2＋浓度1.25 mmol/L透析液不会降低患者血钙水平,iPTH＜ 150 ng/L或＞600 ng/L应用Ca^2＋＋浓度1.50 mmol/L透析液治疗会导致血钙水平偏高,血钙磷乘积明显升高;血iPTH＜ 150 ng/L应用Ca^2＋浓度1.25 mmol/L透析液可刺激甲状旁腺使iPTH升高,对预防低转运骨病有益;应用Ca^2＋浓度1.25 mmol/L透析液可给含钙的磷结合剂治疗提供空间.
Objective To observe the influence of calcium concentration in dialysate on serum levels of calcium,phosphorus and intact parathyroid hormone （iPTH） in with maintenance hemodialysis （MHD）.Methods We changed the calcium concentration in dialysate from 1.50 mmol/L to 1.25 mmol/L in MHD patients with the serum calcium over 2.10 mmol/L for six months,a total of 107 cases were enrolled,and the serum levels of calcium,phosphorus and iPTH at the start of the study and at the end of the study were recorded,respectively.Results After 6 months of treatment,the serum calcium increased and the serum phosphorus reduced slightly in all patients [（2.39 ± 0.22） mmol/L vs （2.32 ± 0.29） mmol/L,（2.04 ± 0.62） mmol/L vs （2.19 ± 0.71）mmol/L] （P 〈 0.05）.The patients were divided into the groups according to the serum iPTH （iPTH 〈 150 ng/L group 20 cases,iPTH 150-300 ng/L group 23 cases,301-600 ng/L group 37 cases and iPTH 〉600 ng/L group 21 cases）.At the start of the study,the serum calcium in the groups with iPTH 〈 150 ng/L and iPTH 〉 600 ng/L were higher than other patients（P 〈0.05）.At the end of the study,the mean of the serum iPTH was 〉 150 ng/L in the group with iPTH 〈 150 ng/L,and there was significant difference （P 〈 0.05）.The serum the serum phosphorus decreased in iPTH 150-300 ng/L group [（1.87 ± 0.55） mmol/L vs （2.09 ± 0.70） mmol/L],but there was no difference（P 〉 0.05）.The serum iPTH and the serum phosphorus reduced slightly in the iPTH 300-600 ng/L group[（410 ±330）ng/L vs （443 ±92）ng/L,（2.03 ± 0.55） mmol/L vs （2.11 ±0.69）mmol/L],but there was no difference,the serum calcium increased [（2.38 ± 0.21） mmol/L vs （2.26 ± 0.22） mmol/L] and there was significant difference （P 〈 0.05）.Conclusions Compared with dialysate （Ca^2＋ ＋ 1.50 mmol/L）,the application of dialysate（Ca^2＋ 1.25 mmol/L）do not reduce the serum calcium level in MHD patients; low calcium dialysate can stimulate the parathyroid gland to increase the IPTH in the patients with the serum iPTH 〈 150 ng/L,which is beneficial to the prevention of low transporters osteonosus.Additionally,the application of low calcium dialysate can provide therapic space to calcium-based phosphate binder therapies.
出处
《中国医药》
2014年第4期562-566,共5页
China Medicine
关键词
血液透析
透析液
血钙
血磷
全段甲状旁腺激素
Hemodialysis
Dialysate
Blood calcium
Blood phosphorus
Intact parathyroid hormone
