中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2015年
6期
429-433
,共5页
季思思%刘毅%陈瑞聪%徐安娣%柯骥
季思思%劉毅%陳瑞聰%徐安娣%柯驥
계사사%류의%진서총%서안제%가기
烟酰胺%高磷血症%肾透析%甲状旁腺素
煙酰胺%高燐血癥%腎透析%甲狀徬腺素
연선알%고린혈증%신투석%갑상방선소
Niacinamide%Hyperphosphatemia%Renal dialysis%Parathyroid hormone
目的 研究在维持性血液透析(MHD)患者中烟酰胺对高磷血症治疗的有效性.方法 采用随机对照研究方法,100例血磷高于1.45 mmol/L的受试者随机分入对照组(n=50)和治疗组(n=50),对照组维持原降磷方案,治疗组在原降磷方案的基础上加用烟酰胺治疗并进行剂量调整.治疗时间为8周,每2周测量1次血清钙、磷浓度,每月测量1次标准化蛋白分解率、全段甲状旁腺素及基础生化指标.结果 共93例完成研究,其中治疗组44例,对照组49例.经重复测量方差分析,加用烟酰胺治疗后可降低血磷水平,与对照组相比差异具有统计学意义(F=23.33,P＜ 0.001),但对血钙水平无影响(F=1.65,P=020).而8周末,两组受试者的血磷水平[(1.59±0.36) mmol/L比(1.94±0.25) mmol/L,P＜0.001]和高密度脂蛋白的水平[(1.32±0.54) mmol/L比(1.09±0.41) mmol/L,P=0.02],均有统计学意义.全段甲状旁腺素、碱性磷酸酶差异无统计学意义(P＞0.05).部分经烟酰胺治疗的患者出现血小板下降及胃肠道反应等不良反应.结论 在服用磷结合剂治疗的基础上,加用烟酰胺可对维持性血液透析高磷血症患者起到良好的降磷作用并带来升高高密度脂蛋白的益处,但治疗时需监测患者血小板.
目的 研究在維持性血液透析(MHD)患者中煙酰胺對高燐血癥治療的有效性.方法 採用隨機對照研究方法,100例血燐高于1.45 mmol/L的受試者隨機分入對照組(n=50)和治療組(n=50),對照組維持原降燐方案,治療組在原降燐方案的基礎上加用煙酰胺治療併進行劑量調整.治療時間為8週,每2週測量1次血清鈣、燐濃度,每月測量1次標準化蛋白分解率、全段甲狀徬腺素及基礎生化指標.結果 共93例完成研究,其中治療組44例,對照組49例.經重複測量方差分析,加用煙酰胺治療後可降低血燐水平,與對照組相比差異具有統計學意義(F=23.33,P＜ 0.001),但對血鈣水平無影響(F=1.65,P=020).而8週末,兩組受試者的血燐水平[(1.59±0.36) mmol/L比(1.94±0.25) mmol/L,P＜0.001]和高密度脂蛋白的水平[(1.32±0.54) mmol/L比(1.09±0.41) mmol/L,P=0.02],均有統計學意義.全段甲狀徬腺素、堿性燐痠酶差異無統計學意義(P＞0.05).部分經煙酰胺治療的患者齣現血小闆下降及胃腸道反應等不良反應.結論 在服用燐結閤劑治療的基礎上,加用煙酰胺可對維持性血液透析高燐血癥患者起到良好的降燐作用併帶來升高高密度脂蛋白的益處,但治療時需鑑測患者血小闆.
목적 연구재유지성혈액투석(MHD)환자중연선알대고린혈증치료적유효성.방법 채용수궤대조연구방법,100례혈린고우1.45 mmol/L적수시자수궤분입대조조(n=50)화치료조(n=50),대조조유지원강린방안,치료조재원강린방안적기출상가용연선알치료병진행제량조정.치료시간위8주,매2주측량1차혈청개、린농도,매월측량1차표준화단백분해솔、전단갑상방선소급기출생화지표.결과 공93례완성연구,기중치료조44례,대조조49례.경중복측량방차분석,가용연선알치료후가강저혈린수평,여대조조상비차이구유통계학의의(F=23.33,P＜ 0.001),단대혈개수평무영향(F=1.65,P=020).이8주말,량조수시자적혈린수평[(1.59±0.36) mmol/L비(1.94±0.25) mmol/L,P＜0.001]화고밀도지단백적수평[(1.32±0.54) mmol/L비(1.09±0.41) mmol/L,P=0.02],균유통계학의의.전단갑상방선소、감성린산매차이무통계학의의(P＞0.05).부분경연선알치료적환자출현혈소판하강급위장도반응등불량반응.결론 재복용린결합제치료적기출상,가용연선알가대유지성혈액투석고린혈증환자기도량호적강린작용병대래승고고밀도지단백적익처,단치료시수감측환자혈소판.
Objective To study the effectiveness of niacinamide in treating maintenance hemodialysis patients with hyperphosphatemia.Methods It was a prospective and randomized controlled trial.Patients with hyperphosphatemia (serum phosphate ＞ 1.45 mmol/L) were randomly assigned into two groups:control group (continue their original phosphate binder and rocaltrol treatment) and niacinamide therapy group (additionally received niacinamide,titrated from 600 mg/d to 1200 mg/d).The treatment lasted for 8 weeks.Serum phosphate and calcium were tested every 2 weeks and normalized protein catabolic rate and other relevant indexes were tested monthly.Results 100 patients were recruited and 93 of them completed the trial,including 44 from the therapy group and 49 from the control group.By the repeated measures analysis of variance,changes of serum phosphate in two groups displayed a statistical significant difference,but the levels of serum calcium in both remained steady.At the end of trial,compared to control group,therapy group appeared decreased serum phosphate levels [(1.59±0.36) mmol/L vs (1.94±0.25) mmol/L,P ＜ 0.001] and increased serum HDL levels [(1.32±0.54) mmol/L vs (1.09±0.41) mmol/L,P=0.02].Meanwhile,two groups showed no significant difference in intact parathyoid hormone and alkaline phosphatase.Adverse reactions including thrombocytopenia and gastrointestinal dysfunction were observed in niacinamide therapy group.Conclusions Niacinamide is effective on controlling hyperphosphatemia along with phosphate binder in maintenance hemodialysis patients.It also increases the serum HDL levels.Nonetheless,it is important to monitor the number of platelet.
