CAJ | 학술논문

目的：探讨碳酸镧对维持性血液透析(maintenance hemodialysis,MHD)患者冠状动脉钙化(coronary artery calcification,CAC)的影响。方法选择2012年6月至2014年1月我科行MHD治疗的终末期肾脏疾病(end-stage renal disease,ESRD)伴高磷血症患者50例,采用随机数字表法分为醋酸钙组和碳酸镧组；2组分别给予不同磷结合剂：醋酸钙组25例,给予醋酸钙治疗；碳酸镧组25例,给予碳酸镧治疗。2组治疗前及治疗后第12个月时采用多层螺旋 CT(multi-slice spiral CT,MSCT)扫描,计算冠状动脉钙化积分(coronary artery calcium score,CACs),评估 CAC 进展,并记录血钙、血磷及全段甲状旁腺素(intact parathyroid hormone,iPTH)的水平。结果50例 MHD患者中47例患者完成试验。醋酸钙组治疗前后的血磷分别为(2.23±0.33)mmol/L 和(1.55±0.38) mmol/L,碳酸镧组治疗前后血磷分别为(2.30±0.3)mmol/L 和(1.54±0.32)mmol/L,2组治疗后血磷水平均有明显下降(P<0.05),2组降血磷作用无统计学差异(P>0.05)。醋酸钙组治疗前后血钙分别为(2.33±0.20)mmol/L和(2.46±0.22)mmol/L,血钙水平明显升高(P<0.05)；碳酸镧组治疗前后血钙分别为(2.39±0.23)mmol/L和(2.25±0.18)mmol/L,血钙水平治疗后有所降低,但差异无统计学意义(P>0.05),2组对血钙影响的差异有统计学意义(P<0.05)。醋酸钙组治疗前后CACs分别为(1123±998)和(1306±1286),CACs治疗后显著增加(P<0.05)；碳酸镧组治疗前后CACs分别为(1216±1033)和(1190±822),治疗前后 CACs 无明显变化(P>0.05),CACs 变化的组间差异有统计学意义(P<0.05)。结论碳酸镧和醋酸钙均能有效降低血磷,但碳酸镧对血钙的影响较小,并能明显延缓CAC的进展。
목적：탐토탄산란대유지성혈액투석(maintenance hemodialysis,MHD)환자관상동맥개화(coronary artery calcification,CAC)적영향。방법선택2012년6월지2014년1월아과행MHD치료적종말기신장질병(end-stage renal disease,ESRD)반고린혈증환자50례,채용수궤수자표법분위작산개조화탄산란조；2조분별급여불동린결합제：작산개조25례,급여작산개치료；탄산란조25례,급여탄산란치료。2조치료전급치료후제12개월시채용다층라선 CT(multi-slice spiral CT,MSCT)소묘,계산관상동맥개화적분(coronary artery calcium score,CACs),평고 CAC 진전,병기록혈개、혈린급전단갑상방선소(intact parathyroid hormone,iPTH)적수평。결과50례 MHD환자중47례환자완성시험。작산개조치료전후적혈린분별위(2.23±0.33)mmol/L 화(1.55±0.38) mmol/L,탄산란조치료전후혈린분별위(2.30±0.3)mmol/L 화(1.54±0.32)mmol/L,2조치료후혈린수평균유명현하강(P<0.05),2조강혈린작용무통계학차이(P>0.05)。작산개조치료전후혈개분별위(2.33±0.20)mmol/L화(2.46±0.22)mmol/L,혈개수평명현승고(P<0.05)；탄산란조치료전후혈개분별위(2.39±0.23)mmol/L화(2.25±0.18)mmol/L,혈개수평치료후유소강저,단차이무통계학의의(P>0.05),2조대혈개영향적차이유통계학의의(P<0.05)。작산개조치료전후CACs분별위(1123±998)화(1306±1286),CACs치료후현저증가(P<0.05)；탄산란조치료전후CACs분별위(1216±1033)화(1190±822),치료전후 CACs 무명현변화(P>0.05),CACs 변화적조간차이유통계학의의(P<0.05)。결론탄산란화작산개균능유효강저혈린,단탄산란대혈개적영향교소,병능명현연완CAC적진전。
Objective Coronary artery calcification (CAC)was strongly associated with future cardiovascular events,and has been identified as a strong independent predictor for cardiovascular mortality in patients undergoing maintenance hemodialysis (MHD).The purpose of this study was to explore the effect of lanthanum on coronal artery calcification in MHD patients.Methods Fifty pa-tients undergoing MHD were randomly divided into 2 groups,receiving either calcium acetate or lan-thanum carbonate,and the CAC scores were evaluated by multi-slice spiral CT (MSCT)scan at study enrollment and after 1 2-month treatment period.Progression of CAC was assessed,and serum levels of Ca,Pi,and intact parathyroid hormone (iPTH)were determined.Results Forty-seven patients completed the study.During this 1 2-month period,the serum phosphate level was decreased signifi-cantly from (2.23±0.33)mmol/L to (1.55 ±0.38)mmol/L in the calcium acetate group (P<0.05),and similarly decreased from (2.30±0.34)mmol/L to (1.54±0.32)mmol/L in the lantha-num carbonate group (P<0.05).Changes in serum phosphate level between two groups were not sig-nificantly different (P>0.05).The serum calcium level showed a significant increase in the calcium acetate group [(2.33±0.20)mmol/L at baseline and (2.46±0.22)mmol/L at study completion,P<0.05],but no significant change in the lanthanum carbonate group [(2.39±0.23)mmol/L at base-line and (2.25±0.18)mmol/L at study completion,P>0.05].Changes in serum calcium level be-tween two groups showed significant difference (P<0.05).The CACs showed a significant increase in the calcium acetate group [(1 123±998)at baseline and (1 306±1 286)at study completion,P<0.05],but no significant change was found in the lanthanum carbonate group [(1 216 ± 1 033)at baseline and (1 190±822)at study completion,P>0.05].Changes in CACs were significantly smal-ler in lanthanum carbonate group than in calcium acetate group (P<0.05).Conclusions Lanthanum carbonate or calcium acetate is similarly effective in decreasing serum phosphate level,whereas the for-mer shows significant advantages in controlling serum calcium level and delaying progression of CAC in patients undergoing MHD over the latter.