中国血液净化

中国血液净化 ›› 2019, Vol. 18 ›› Issue (01): 21-25.doi: 10.3969/j.issn.1671-4091.2019.01.005

• 临床研究 • 上一篇    下一篇

低钙透析对维持性血液透析患者钙磷代谢及甲状旁腺激素影响的Meta 分析

黄盈   

  1. 中国人民解放军南部战区总医院血液透析室
  • 收稿日期:2018-05-21 修回日期:2018-11-01 出版日期:2019-01-12 发布日期:2018-12-25
  • 通讯作者: 黄盈 huangy_sci@163.com E-mail:huangy_sci@163.com

Effects of low calcium dialysate on calcium-phosphorus metabolism and parathyroid hormone level in maintenance hemodialysis patients: a meta- analysis

  • Received:2018-05-21 Revised:2018-11-01 Online:2019-01-12 Published:2018-12-25

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摘要： 【摘要】目的探讨低钙(1.25mmol/L)透析液在维持性血液透析(maintenance hemodialysis，MHD)患者中的应用及其对血钙、血磷和全段甲状旁腺激素(intact parathyroid hormone，iPTH)控制效果。方法通过检索中国知网、万方数据、维普、中国生物医学文献数据库和PubMed 数据库，对近10 年内关于低钙透析液在MHD 患者中的临床应用研究进行Meta 分析，比较低钙透析液组(low calcium dialysate，LCD 组)和1.5 mmol/L 钙浓度透析液组(high calcium dialysate，HCD 组)血钙、血磷和iPTH 水平的变化。结果共纳入11 篇国内外文献。Meta 分析结果显示，LCD 组血钙水平显著低于HCD 组(SMD=-0.679, 95% CI: -1.157～-0.202,P=0.005)，2 种透析液降磷效果无显著差异(SMD=-0.824,95% CI: -1.733～0.085,P=0.076)，LCD 组iPTH 水平高于HCD 组(SMD=1.235,95% CI: 0.555～1.915,P＜0.001)。结论低钙透析可降低患者的血钙和磷水平，可致iPTH 水平升高；标准透析可致血钙上升，血磷下降，iPTH 水平稳定波动；2种透析液降磷效果无显著差异。

关键词: 低钙透析, 血钙, 血磷, iPTH, Meta分析

Abstract: 【Abstract】Objective To study the application of low calcium dialysate (1.25 mmol/L) in maintenance hemodialysis (MHD) patients and survey its clinical effects on serum calcium (Ca), phosphate (P) and intact parathyroid hormone (iPTH). Methods By search of publications in the last 10 years in CNKI, Wanfang China Science Periodical Database (CSPD), VIP China Science and Technology Journal Database (CSTJ), SinoMed database and PubMed database, a meta-analysis was performed using the publications about the clinical application of low calcium dialysate in MHD patients, and the levels of serum calcium, phosphate and iPTH were then compared between MHD patients using low calcium dialysate (LCD) and calcium 1.5 mmol/L dialysate (HCD). Results Eleven publications were included in the meta-analysis. Serum Ca level in patients using LCD was lower than that in those using HCD (SMD=-0.679, 95% CI -1.157～-0.202, P=0.005). Serum P had no significantly difference between patients using LCD and those using HCD (SMD=-0.824,
95% CI -1.733～0.085, P=0.076). iPTH level was significant higher in patients using LCD than in those using HCD (SMD=1.235, 95% CI 0.555～1.915, P＜0.001). Conclusion LCD can decrease the levels of serum Ca and P and increase the level of iPTH, while HCD can increase the level of serum Ca, decrease the level of serum P, and have no significant effect on iPTH. These two kinds of dialysate have similar effect on the decrease of serum P.

Key words: low calcium dialysates, serum calcium, serum phosphate, iPTH, meta-analysis