中国血液净化

›› 2005, Vol. 4 ›› Issue (10): 531-534.

• 论著 • 上一篇    下一篇

比较血液透析患者在不同PTH状态下低钙透析液的疗效

魏守亮1 张 凌2 陆文进2
  

  1. 255000 1. 淄博，山东省淄博市第三人民医院血液净化中心 100029 2. 北京，中日友好医院肾病中心
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2005-10-12 发布日期:2005-10-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2005-10-12 Published:2005-10-12

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摘要： 目的 通过观察不同甲状旁腺激素(PTH)状态下合并高钙血症的血液透析患者应用低钙透析液的疗效，以肯定其实用性。方法 选择27例维持性血液透析合并高钙血症患者，根据iPTH水平分为三组： I组血iPTH＜120pg/ml，考虑低转运骨病(low turnover bone diease, LTBD)，共6例；II组血iPTH不相识 120～600 pg/ml，即PTH合适或轻度甲状旁腺功能亢进组，共13例；III组血iPTH 600～1000pg/ml,重度继发甲旁亢需活性维生素D冲击治疗组，共8例；三组患者应用低钙透析液(1.25mmol/L）三个月后比较血清钙、磷、钙磷乘积及血iPTH的变化。结果 应用低钙透析液后，三组患者透析前、后血钙都有明显下降（P＜0.05），尤其透析后血钙下降更明显(P＜0.01)；透析前、后血磷变化不大；透析前、后钙磷乘积全部下降(P＜0.05)； LTBD 组iPTH明显升高(P＜0.05)，其余二组iPTH虽有所升高，但无显著性差异(P＞0.05)。观察中不良反应的发生率为6/27(22.2%），主要有肌痉挛、低血压和心律失常，除1例肌痉挛不能耐受而退出以外，余5例经对症处理后尚能坚持完成3个月的观察。结论 对不同原因导致的血液透析患者高钙血症，包括活性维生素D冲击治疗及LTBD患者，都适宜个体化的低钙透析液进行透析，可以降低高钙血症及钙磷乘积，但要定期监测血清钙、磷及PTH的变化。

关键词: 低钙透析液, 钙磷乘积, 肾性骨病, 血液透析

Abstract: Objective To investigate the effects of the low calcium dialysate on the serum calcium(Ca), phosphate(P), Calcium-phosphate product(Ca×P) and iPTH in hemodialysis patients with different PTH level. Methods Twenty-seven maintenance hemodialysis patients who were hypercalcaemia were divided into three groups according to different iPTH level: group I: iPTH＜120 pg/ml, with low turnover bone disease (LTBD); group II: iPTH 120～600pg/ml; group III: iPTH＞600pg/ml with severe secondary hyperparathyroidism need the active vitamin D therapy. Low calcium dialysate(1.25mmol/l) were applied to the patients three months.The variety of Ca, P, (Ca×P) and iPTH were applied to. Results After using the low calcium dialysate, Ca of the three groups before and ofter hemodialysisly decreased significant (P＜0.05 and P ＜0.01 respectively ); there were no significant difference of P(P＞0.05); Ca×P decreased significantly (P＜0.05); iPTH of group I significant increased (P＜0.05); iPTH of group II and group III increased slightly, but there were no significant difference( P＞0.05). The rates of adverse reaction is 6/27(22.2%), include muscle spasm, hypotension and arrhythmia. Conclusions In the hemodialysis patients with hypercalcaemia, include different reasons as active vitamin D therapy and LTBD, Using of the individual low calcium dialysate can decrease Ca and. Ca×P We should pay attention that low calcium dialysate may increase PTH severetion.

Key words: Ca×P, Renal osteodystrophy, Hemodialysis

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