低甲状旁腺激素水平的血液透析患者应用1.25mmol/L钙浓度透析液的临床观察

王海涛; 吴华; 毛永辉

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中国血液净化 ›› 2006, Vol. 5 ›› Issue (7) : 355-357.

论著

低甲状旁腺激素水平的血液透析患者应用1.25mmol/L钙浓度透析液的临床观察

王海涛吴华毛永辉

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摘要

目的探讨应用1.25mmol/L钙浓度透析液对于低甲状旁腺激素(iPTH)水平的血液透析（HD）患者钙磷代谢及甲状旁腺功能的影响。方法选择北京医院血液净化中心26例血清全段iPTH水平低于100pg/ml的HD患者，应用1.25mmol/L钙浓度透析液，同时停用活性维生素D治疗。观察12个月，比较观察前与3个月、6个月和12个月后血清钙、磷、钙磷乘积及iPTH的变化。结果应用低钙透析液3个月后患者血钙显著下降[(2.63±0.29)mmol/L vs (2.38±0.13)mmol/L，P＜0.05]，此后保持稳定，不再继续下降。血磷浓度呈逐渐下降趋势，但差异无显著性。钙磷乘积在进入观察后3个月时已有显著下降[(53.14±13.6) mg2/dl2 vs(46.74 ± 9.47)mg2/dl2，P＜0.05]，此后仍呈下降趋势，但较3个月时差异无显著性。6个月时血清iPTH由观察前的(57.79±36.61)pg/ml升高至(131.12±76.17)pg/ml(P ＜0.05),此后继续保持此水平。结论 1.25mmol/L钙浓度透析液可以降低血钙和钙磷乘积水平，改善被过度抑制的甲状旁腺功能；在维持血钙正常的情况下，较少发生甲状旁腺的过度刺激, 适合应用于有高血钙倾向、且钙化危险性增加的低iPTH水平的透析患者。

Abstract

Objective To investigate the effect of low-calcium dialysate(1.25mmol/L) on calcium and phosphate metabolism and parathyroid hormone secretion in hemodialysis(HD) patients with secondary hypoparathyroidism. Methods Twenty-six HD patients with low level of intact parathyroid hormone (iPTH＜100pg/ml) were treated with 1.25mmol/L calcium dialysate for 12 months. Calcium carbonate were given as phosphrous binder or calcium supplement， and the active Vitamin D were not applied. Results Serum calcium concentration decreased significantly from (2.63±0.29) mmol/L at baseline to (2.38±0.13)mmol/L after 3 months and remained in this range thereafter. Calcium-phosphorous product(Ca x P)had the same change as calcium from(53.14±13.67)mg2/dl2 at baseline to (46.74±9.47)mg2/dl2 after 3 months(P＜0.05). iPTH level increased significantly from baseline (57.79±36.61)pg/ml to a maximum of (131.12±76.17)pg/ml at 6 months（P＜0.05）,then remained stable. Conclusion The treatment with 1.25mmol/L calcium dialysate effectively decreased serum calcium and Ca x P, stimulated the secretion of parathyroid hormone, and is suitable for HD patients with a relative PTH deficiency, who have tendency to hypercalcemia and calciphylaxis.