目的 观察长期应用钙离子浓度为1.25 mmol/L的低钙透析液(LCaD)对血液透析患者钙磷代谢的影响.方法 本研究共纳入38例稳定透析患者,以1.25 mmol/L钙浓度透析液替换原使用的1.75mmol/L钙浓度透析液(HCaD),回顾性观察使用低钙透析液2年后患者血清钙、磷、钙磷乘积、全段甲状旁腺素(iPTH)等指标的变化.结果 与高钙透析液相比,整体观察,采用低钙透析液后患者血钙水平降低[HCaD(2.32±0.23)mmol/L,LCaD(2.21±0.24)mmoI/L;t=2.286,P=0.028],iPTH水平明显升高[HCaD(20.92±16.04)pmoL/L,LCaD(40.02±30.55)pmoL/L;t=-4.029,P=0.000],血磷及钙磷乘积变化不明显.按照基点处iPTH水平分组观察,低iPTH组(iPTH＜11.0 pmol/L)患者的血钙水平较前下降[HCaD(2.46±0.19)mmoL/L,LCaD(2.11±0.23)mmol/L;t=4.047,P=0.002],钙磷乘积下降[HCaD(4.75±1.66)mmol2/L2,LCaD(3.54±0.77)mmol2/L2;t=3.784,P=0.004],血磷保持稳定,iPTH水平中度升高[HCaD(5.67±2.84)pmol/L;LCaD(27.72±27.79)pmol/L;t=-2.490,P:0.032].高iPTH组(iPTH≥11.0 pmol/L)患者的血钙、血磷及钙磷乘积未见显著差异,iPTH水平显著升高[HCaD(27.15±15.43)pmol/L,LCaD(45.03±30.68)pmol/L;t=-3.138,P=0.004].按照基点处血钙水平分组观察,低血钙组(Ca＜2.10 mmol/L)和正常血钙组(ca 2.10-2.37 mmol/L)患者的钙、磷、钙磷乘积基本保持相对稳定.高血钙组(ca＞2.37 mmol/L)患者的血钙水平下降[HCaD(2.52±0.12)mmol/L,LCaD(2.25±0.20)mmol/L;t=4.153,P=0.001],血磷水平保持稳定,钙磷乘积下降[HCaD(4.94±1.19)mmol2/L2,LCaD(4.10±0.80)mmol2/L2;t=2.587,P=0.012].iPTH水平于低血钙组保持相对稳定,于正常血钙组[HCaD(20.18±11.00)pmol/L;LCaD(37.45±32.61)pmol/L;t=-2.351,P=0.032]和高血钙组[HCaD(14.68±12.98)pmol/L,LCaD(40.19±33.20)pmol/L;t=-3.432,P=0.004]均有升高.结论 1.25 mmoL/L钙浓度透析液可应用于多数不同血钙浓度的患者,长期应用低钙透析液可以降低血钙,促进PTH分泌,有利于减少转移性钙化和动力缺失性骨病的发生,但同时增加了继发性甲状旁腺功能亢进的风险.
目的 觀察長期應用鈣離子濃度為1.25 mmol/L的低鈣透析液(LCaD)對血液透析患者鈣燐代謝的影響.方法 本研究共納入38例穩定透析患者,以1.25 mmol/L鈣濃度透析液替換原使用的1.75mmol/L鈣濃度透析液(HCaD),迴顧性觀察使用低鈣透析液2年後患者血清鈣、燐、鈣燐乘積、全段甲狀徬腺素(iPTH)等指標的變化.結果 與高鈣透析液相比,整體觀察,採用低鈣透析液後患者血鈣水平降低[HCaD(2.32±0.23)mmol/L,LCaD(2.21±0.24)mmoI/L;t=2.286,P=0.028],iPTH水平明顯升高[HCaD(20.92±16.04)pmoL/L,LCaD(40.02±30.55)pmoL/L;t=-4.029,P=0.000],血燐及鈣燐乘積變化不明顯.按照基點處iPTH水平分組觀察,低iPTH組(iPTH＜11.0 pmol/L)患者的血鈣水平較前下降[HCaD(2.46±0.19)mmoL/L,LCaD(2.11±0.23)mmol/L;t=4.047,P=0.002],鈣燐乘積下降[HCaD(4.75±1.66)mmol2/L2,LCaD(3.54±0.77)mmol2/L2;t=3.784,P=0.004],血燐保持穩定,iPTH水平中度升高[HCaD(5.67±2.84)pmol/L;LCaD(27.72±27.79)pmol/L;t=-2.490,P:0.032].高iPTH組(iPTH≥11.0 pmol/L)患者的血鈣、血燐及鈣燐乘積未見顯著差異,iPTH水平顯著升高[HCaD(27.15±15.43)pmol/L,LCaD(45.03±30.68)pmol/L;t=-3.138,P=0.004].按照基點處血鈣水平分組觀察,低血鈣組(Ca＜2.10 mmol/L)和正常血鈣組(ca 2.10-2.37 mmol/L)患者的鈣、燐、鈣燐乘積基本保持相對穩定.高血鈣組(ca＞2.37 mmol/L)患者的血鈣水平下降[HCaD(2.52±0.12)mmol/L,LCaD(2.25±0.20)mmol/L;t=4.153,P=0.001],血燐水平保持穩定,鈣燐乘積下降[HCaD(4.94±1.19)mmol2/L2,LCaD(4.10±0.80)mmol2/L2;t=2.587,P=0.012].iPTH水平于低血鈣組保持相對穩定,于正常血鈣組[HCaD(20.18±11.00)pmol/L;LCaD(37.45±32.61)pmol/L;t=-2.351,P=0.032]和高血鈣組[HCaD(14.68±12.98)pmol/L,LCaD(40.19±33.20)pmol/L;t=-3.432,P=0.004]均有升高.結論 1.25 mmoL/L鈣濃度透析液可應用于多數不同血鈣濃度的患者,長期應用低鈣透析液可以降低血鈣,促進PTH分泌,有利于減少轉移性鈣化和動力缺失性骨病的髮生,但同時增加瞭繼髮性甲狀徬腺功能亢進的風險.
목적 관찰장기응용개리자농도위1.25 mmol/L적저개투석액(LCaD)대혈액투석환자개린대사적영향.방법 본연구공납입38례은정투석환자,이1.25 mmol/L개농도투석액체환원사용적1.75mmol/L개농도투석액(HCaD),회고성관찰사용저개투석액2년후환자혈청개、린、개린승적、전단갑상방선소(iPTH)등지표적변화.결과 여고개투석액상비,정체관찰,채용저개투석액후환자혈개수평강저[HCaD(2.32±0.23)mmol/L,LCaD(2.21±0.24)mmoI/L;t=2.286,P=0.028],iPTH수평명현승고[HCaD(20.92±16.04)pmoL/L,LCaD(40.02±30.55)pmoL/L;t=-4.029,P=0.000],혈린급개린승적변화불명현.안조기점처iPTH수평분조관찰,저iPTH조(iPTH＜11.0 pmol/L)환자적혈개수평교전하강[HCaD(2.46±0.19)mmoL/L,LCaD(2.11±0.23)mmol/L;t=4.047,P=0.002],개린승적하강[HCaD(4.75±1.66)mmol2/L2,LCaD(3.54±0.77)mmol2/L2;t=3.784,P=0.004],혈린보지은정,iPTH수평중도승고[HCaD(5.67±2.84)pmol/L;LCaD(27.72±27.79)pmol/L;t=-2.490,P:0.032].고iPTH조(iPTH≥11.0 pmol/L)환자적혈개、혈린급개린승적미견현저차이,iPTH수평현저승고[HCaD(27.15±15.43)pmol/L,LCaD(45.03±30.68)pmol/L;t=-3.138,P=0.004].안조기점처혈개수평분조관찰,저혈개조(Ca＜2.10 mmol/L)화정상혈개조(ca 2.10-2.37 mmol/L)환자적개、린、개린승적기본보지상대은정.고혈개조(ca＞2.37 mmol/L)환자적혈개수평하강[HCaD(2.52±0.12)mmol/L,LCaD(2.25±0.20)mmol/L;t=4.153,P=0.001],혈린수평보지은정,개린승적하강[HCaD(4.94±1.19)mmol2/L2,LCaD(4.10±0.80)mmol2/L2;t=2.587,P=0.012].iPTH수평우저혈개조보지상대은정,우정상혈개조[HCaD(20.18±11.00)pmol/L;LCaD(37.45±32.61)pmol/L;t=-2.351,P=0.032]화고혈개조[HCaD(14.68±12.98)pmol/L,LCaD(40.19±33.20)pmol/L;t=-3.432,P=0.004]균유승고.결론 1.25 mmoL/L개농도투석액가응용우다수불동혈개농도적환자,장기응용저개투석액가이강저혈개,촉진PTH분비,유리우감소전이성개화화동력결실성골병적발생,단동시증가료계발성갑상방선공능항진적풍험.
Objective To observer the long term effect of 1.25 mmol/L calcium concentrate dialysate (LCaD)on calcium-phosphate metabolism in hemodialysis patients.Methods This study included 38 patients.They were maintained hemodialysis with 1.75 mm01/L calcium concentrate dialysate(HCaD)more than 1 years,and then changed to LCaD for 2 years.Albumin-adjusted seFum calcium,phosphate,calcium x phosphate(Ca×P)product.and intact parathyroid hormone(iPTH)before and after application of LCaD were compared.Results Serum calcium decreased[HCaD(2.32±0.23)mmoL/L,LCaD(2.21±0.24)mmol/L;t=2.286,P=0.028]and iPTH increased[HCaD(20.92±16.04)pmol/,L,LCaD(40.02±30.55)pmol/L;t=-4.029,P=0.000],the phosphate and Ca×P product did not changed obviously.In the low iPTH group(iPTH＜11.Opmol/L),the levels of calcium[HCaD(2.46±0.19)mmol/L,LCaD(2.11±0.23)mmol/L;t=4.047,P=0.002]and Ca×P product [HCaD(4.75 ±1.66)mmol2/L2,LCaD(3.54±0.77)mmol2/L2;t=3.784,P=0.004]decreased,the iPTH increased moderately[HCaD(5.67±2.84)pmol/L;LCaD(27.72±27.79)pmol/L;t=-2.490,P=0.032],the serum phosphate keept stable.In the high iPTH group(iPTH≥11.0 pmol/L),the levers of calcium,phosphate and Ca×P product did not changed obviously,but the iPTH lever increased significantly[HCaD(27.15±15.43)pmol/L.LCaD(45.03±30.68)pmol/L; t=-3.138,P=0.004].Observer according the serum calcium at the baseline.the levers of calcium,phosphate and Ca×P product kept stable in the low(Ca＜2.10 mmol/L)and normal calcium(Ca:2.10～2.37 mmol/L)patients.But in the high calcium(Ca＞2.37 mmol/L)patients,the levers of ca]cium[HCaD(2.52±0.12)mmol/L,LCaD(2.25±0.20)mmol/L;t=4.153,P=0.001]and Ca×P product [HCaD(4.94±1.19)mmol2/L2.LCaD(4.10±0.80)mmol2/L2;t=2.587,P=0.012]decreased.The iPTH level kept stable in the low calcium patients,but jncreased in the normal[HCaD(20.18±11.00)pmol/L;LCaD(37.45±32.61)pmol/L;t=-2.351,P=0.032]and high calcium[HCaD(14.68±12.98)pmol/L,LCaD(40.19±33.20)pmol/L;t=-3.432,P=0.004]patients.Conclusion The LCaD could decreased the serum calcium levers and stimulated the PTH secretion.that may reduce the risks of adynamic bone diseases and soft tissue calcifications,but increased the risk of second hyperparathyroidism.
