司维拉姆联合骨化三醇冲击治疗对血清钙、磷的影响(1)
摘要：目的 观察碳酸司维拉姆在维持性血液透析(MHD)患者联合使用骨化三醇胶丸(罗盖全)冲击治疗继发性甲状旁腺功能亢进时对血清钙、磷水平的影响。方法 维持性血液透析患者30例，甲状旁腺素600～900 pg/ml、血磷>1.78 mmol/L、血钙(2.14±0.32) mmol/L，所有患者均行碳酸氢盐透析治疗，透析3 次/w，4 h/次，透析液钙离子浓度为1.5 mmol/L；将其分为两组，第1组为司维拉姆组，共16例患者，给予口服司维拉姆800 mg，3 次/d，联合骨化三醇2.0 μg，冲击治疗2 次/w；第2组为碳酸钙组，共14例患者，给以口服碳酸钙D 600 mg，1 次/d，联合骨化三醇2.0 μg，冲击治疗2 次/w，监測两组患者血钙、血磷及iPTH水平的变化。结果 司维拉姆组2个月后血磷及iPTH较治疗前明显下降，血钙较治疗前无明显变化，血磷较碳酸钙组有明显下降，差异有统计学意义(P<0.05)。结论 司维拉姆能有效改善MHD患者联合骨化三醇冲击治疗继发性甲状旁腺功能亢进症时的高磷血症，而对血钙无明显影响。
, 百拇医药 关键词：碳酸司维拉姆；骨化三醇；继发性甲状旁腺功能亢进症；维持性血液透析
Effect of Sevelamer Hydrochloride on Serum Calcium and Serum Phosphorus Using Calcitriol Pulse Therapy
LIU Hong-yan
(Department of Nephrology，The Fifth Affiliated Hospital of Xinjiang Medical University，Urumqi 830001，Xinjiang，China)
Abstract：Objective To investigate the effect of sevelamer hydrochloride (renagel)on serum calcium and serum phosphorus in maintenance hemodialysis(MHD)patients with secondary hyperparathyroidism(SHPT) treated by calcitriol pulse theraphy.Methods Thirty MHD patients，with intact parathormone(iPTH)levels of 600～900pg/mL，were treated with calcitriol(2.0 g，biw)pulse therapy.Sixteen of the patients(the study group)were treated with oral renagel (800 mg/d，rid)，and fourteen of the patients(the control group)were treated with calcium carbonate 600 mg/d.Serum phosphate，calcium and iPTH were examined within 2 months of therapy.Results Serium phosphate and iPTH levels 2 months after treatment in the study group were significantly lower than those before treatment，but the serum calcium levels had no significant change.The levels of serum phosphate in the study group were significantly lower than those in the control group(P<0.05).Conclusion Sevelamer serves as a uscful approach for improving the hyperphosphatemia in MHD patients with SHPT using calcitriol pulse therapy，and serum calcium levels had no significant change.
, 百拇医药
Key words：Sevelamer；Calcitriol；secondary hyperparathyroidism；Maintenance hemodialysis
维持性血液透析(MHD)患者普遍存在不同程度的水、电解质和酸碱平衡失调。其中，高磷血症是最常见的并发症之一[1]，伴随血磷水平的升高，出现继发性甲状旁腺功能亢进症、维生素D代谢障碍、肾性骨病及心血管系统钙化，影响患者的生活质量及预后[2]，对于继发性甲状旁腺功能亢进症临床上常采用骨化三醇冲击治疗，因活性维生素D3可增加肠道钙磷的吸收，而血液透析对血磷的清除又十分有限，因此治疗中常出现高钙、高磷血症，影响冲击治疗的顺利进行[3-4]，现本实验选取30例维持性血液透析患者观察使用碳酸司维拉姆联合骨化三醇冲击治疗继发性甲状旁腺功能亢进症时对血清钙、磷水平的影响。
1 资料与方法
1.1一般资料 研究对象均为新疆医科大学第五附属医院血液透析中心2014年6月～2016年1月维持性血液透析患者30例，甲状旁腺素600～900 pg/ml、血磷>1.78 mmol/L、血钙(2.14±0.32)mmol/L，年龄30～82岁，平均56岁，男18例，女12 例；原发病为慢性肾小球肾炎17例，糖尿病肾病8例，高血压肾损害4例，多囊肾1例。除外原发性高钙血症、原发性甲状旁腺功能亢进症、肾小管性酸中毒、多发性骨髓瘤、肝功能异常、严重的胃肠道疾病、难以控制的高血压或糖尿病及严重心衰患者等。所有患者均使用碳酸氢盐透析，每周透析3次，4 h/次，透析液钙离子浓度为1.5 mmol/L。, 百拇医药(刘红艳)
, 百拇医药 关键词：碳酸司维拉姆；骨化三醇；继发性甲状旁腺功能亢进症；维持性血液透析
Effect of Sevelamer Hydrochloride on Serum Calcium and Serum Phosphorus Using Calcitriol Pulse Therapy
LIU Hong-yan
(Department of Nephrology，The Fifth Affiliated Hospital of Xinjiang Medical University，Urumqi 830001，Xinjiang，China)
Abstract：Objective To investigate the effect of sevelamer hydrochloride (renagel)on serum calcium and serum phosphorus in maintenance hemodialysis(MHD)patients with secondary hyperparathyroidism(SHPT) treated by calcitriol pulse theraphy.Methods Thirty MHD patients，with intact parathormone(iPTH)levels of 600～900pg/mL，were treated with calcitriol(2.0 g，biw)pulse therapy.Sixteen of the patients(the study group)were treated with oral renagel (800 mg/d，rid)，and fourteen of the patients(the control group)were treated with calcium carbonate 600 mg/d.Serum phosphate，calcium and iPTH were examined within 2 months of therapy.Results Serium phosphate and iPTH levels 2 months after treatment in the study group were significantly lower than those before treatment，but the serum calcium levels had no significant change.The levels of serum phosphate in the study group were significantly lower than those in the control group(P<0.05).Conclusion Sevelamer serves as a uscful approach for improving the hyperphosphatemia in MHD patients with SHPT using calcitriol pulse therapy，and serum calcium levels had no significant change.
, 百拇医药
Key words：Sevelamer；Calcitriol；secondary hyperparathyroidism；Maintenance hemodialysis
维持性血液透析(MHD)患者普遍存在不同程度的水、电解质和酸碱平衡失调。其中，高磷血症是最常见的并发症之一[1]，伴随血磷水平的升高，出现继发性甲状旁腺功能亢进症、维生素D代谢障碍、肾性骨病及心血管系统钙化，影响患者的生活质量及预后[2]，对于继发性甲状旁腺功能亢进症临床上常采用骨化三醇冲击治疗，因活性维生素D3可增加肠道钙磷的吸收，而血液透析对血磷的清除又十分有限，因此治疗中常出现高钙、高磷血症，影响冲击治疗的顺利进行[3-4]，现本实验选取30例维持性血液透析患者观察使用碳酸司维拉姆联合骨化三醇冲击治疗继发性甲状旁腺功能亢进症时对血清钙、磷水平的影响。
1 资料与方法
1.1一般资料 研究对象均为新疆医科大学第五附属医院血液透析中心2014年6月～2016年1月维持性血液透析患者30例，甲状旁腺素600～900 pg/ml、血磷>1.78 mmol/L、血钙(2.14±0.32)mmol/L，年龄30～82岁，平均56岁，男18例，女12 例；原发病为慢性肾小球肾炎17例，糖尿病肾病8例，高血压肾损害4例，多囊肾1例。除外原发性高钙血症、原发性甲状旁腺功能亢进症、肾小管性酸中毒、多发性骨髓瘤、肝功能异常、严重的胃肠道疾病、难以控制的高血压或糖尿病及严重心衰患者等。所有患者均使用碳酸氢盐透析，每周透析3次，4 h/次，透析液钙离子浓度为1.5 mmol/L。, 百拇医药(刘红艳)