中国医药
中國醫藥
중국의약
CHINA MEDICINE
2014年
4期
562-566
,共5页
阮彩霞%李伟%董巧荣%陈文梅
阮綵霞%李偉%董巧榮%陳文梅
원채하%리위%동교영%진문매
血液透析%透析液%血钙%血磷%全段甲状旁腺激素
血液透析%透析液%血鈣%血燐%全段甲狀徬腺激素
혈액투석%투석액%혈개%혈린%전단갑상방선격소
Hemodialysis%Dialysate%Blood calcium%Blood phosphorus%Intact parathyroid hormone
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Ca2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Ca2+1.25 mmol/L透析液,共107例,脱落6例.将患者应用Ca2浓度1.50 mmol/L透析液时及应用Ca2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Ca2浓度1.25 mmol/L透析液后较应用Ca2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Ca2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Ca2浓度1.25 mmol/L后较应用Ca2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Ca2浓度1.25 mmol/L后较应用Ca2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Ca2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Ca2+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Ca2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Ca2浓度1.25 mmol/L透析液可给含钙的磷结合剂治疗提供空间.
目的 觀察透析鈣濃度對維持性血液透析患者血鈣、燐及甲狀徬腺激素(iPTH)的影響.方法 將北京安貞醫院應用Ca2濃度1.50 mmol/L透析液進行血液透析治療的患者中血鈣超過2.10 mmol/L的患者改用Ca2+1.25 mmol/L透析液,共107例,脫落6例.將患者應用Ca2濃度1.50 mmol/L透析液時及應用Ca2濃度1.25 mmol/L透析液6箇月後血鈣、燐和iPTH的化驗數值進行統計分析,併根據血iPTH水平進行分組分析.結果 110例應用Ca2濃度1.25 mmol/L透析液後較應用Ca2濃度1.50 mmol/L透析液血鈣升高[(2.39±0.22) mmol/L比(2.32±0.29) mmol/L]、血燐降低[(2.04±0.62) mmol/L比(2.19 ±0.71) mmol/L] (P ＜0.05).血iPTH＜ 150 ng/L組20例,iPTH 150～300 ng/L組23例,301 ～600 ng/L組37例,iPTH＞ 600 ng/L組21例.血iPTH＜ 150 ng/L組應用Ca2濃度1.25 mmol/L透析液進行血液透析6箇月後血iPTH均值＞150 ng/L,差異有統計學意義(P＜0.05);iPTH150～300 ng/L組應用Ca2濃度1.25 mmol/L後較應用Ca2濃度1.50 mmol/L透析液血燐下降[(1.87±0.55) mmol/L比(2.09 ± 0.70) mmol/L],但差異無統計學意義(P＞0.05);iPTH 301 ～ 600 ng/L組應用Ca2濃度1.25 mmol/L後較應用Ca2濃度1.50 mmol/L透析液iPTH和血燐略下降[(410±330) ng/L比(443 ± 92) ng/L,(2.03±0.55) mmol/L比(2.11 ±0.69) mmol/L],差異無統計學意義(P＞0.05),血鈣升高差異有統計學意義[(2.38±0.21) mmol/L比(2.26 ±0.22) mmol/L] (P ＜0.05).結論 應用Ca2濃度1.25 mmol/L透析液不會降低患者血鈣水平,iPTH＜ 150 ng/L或＞600 ng/L應用Ca2+濃度1.50 mmol/L透析液治療會導緻血鈣水平偏高,血鈣燐乘積明顯升高;血iPTH＜ 150 ng/L應用Ca2濃度1.25 mmol/L透析液可刺激甲狀徬腺使iPTH升高,對預防低轉運骨病有益;應用Ca2濃度1.25 mmol/L透析液可給含鈣的燐結閤劑治療提供空間.
목적 관찰투석개농도대유지성혈액투석환자혈개、린급갑상방선격소(iPTH)적영향.방법 장북경안정의원응용Ca2농도1.50 mmol/L투석액진행혈액투석치료적환자중혈개초과2.10 mmol/L적환자개용Ca2+1.25 mmol/L투석액,공107례,탈락6례.장환자응용Ca2농도1.50 mmol/L투석액시급응용Ca2농도1.25 mmol/L투석액6개월후혈개、린화iPTH적화험수치진행통계분석,병근거혈iPTH수평진행분조분석.결과 110례응용Ca2농도1.25 mmol/L투석액후교응용Ca2농도1.50 mmol/L투석액혈개승고[(2.39±0.22) mmol/L비(2.32±0.29) mmol/L]、혈린강저[(2.04±0.62) mmol/L비(2.19 ±0.71) mmol/L] (P ＜0.05).혈iPTH＜ 150 ng/L조20례,iPTH 150～300 ng/L조23례,301 ～600 ng/L조37례,iPTH＞ 600 ng/L조21례.혈iPTH＜ 150 ng/L조응용Ca2농도1.25 mmol/L투석액진행혈액투석6개월후혈iPTH균치＞150 ng/L,차이유통계학의의(P＜0.05);iPTH150～300 ng/L조응용Ca2농도1.25 mmol/L후교응용Ca2농도1.50 mmol/L투석액혈린하강[(1.87±0.55) mmol/L비(2.09 ± 0.70) mmol/L],단차이무통계학의의(P＞0.05);iPTH 301 ～ 600 ng/L조응용Ca2농도1.25 mmol/L후교응용Ca2농도1.50 mmol/L투석액iPTH화혈린략하강[(410±330) ng/L비(443 ± 92) ng/L,(2.03±0.55) mmol/L비(2.11 ±0.69) mmol/L],차이무통계학의의(P＞0.05),혈개승고차이유통계학의의[(2.38±0.21) mmol/L비(2.26 ±0.22) mmol/L] (P ＜0.05).결론 응용Ca2농도1.25 mmol/L투석액불회강저환자혈개수평,iPTH＜ 150 ng/L혹＞600 ng/L응용Ca2+농도1.50 mmol/L투석액치료회도치혈개수평편고,혈개린승적명현승고;혈iPTH＜ 150 ng/L응용Ca2농도1.25 mmol/L투석액가자격갑상방선사iPTH승고,대예방저전운골병유익;응용Ca2농도1.25 mmol/L투석액가급함개적린결합제치료제공공간.
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 (Ca2 + 1.50 mmol/L),the application of dialysate(Ca2+ 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.
