摘要
目的:研究应用钙离子1.25mmol/L透析液进行透析6个月对患者免疫反应性甲状旁腺素(iPTH)及钙磷水平的影响。方法:在规律性血透的患者中,选择透前或透后高钙血症的患者16例。入选前,所有患者均采用钙离子1.75mmol/L透析液,每周透析3次,每次4小时,均使用聚砜膜透析器,面积为1.3m2。使用钙离子1.25mmol/l(DCa1.25)透析液透析期间,患者饮食中钙磷的摄入量稳定,且根据需要伴高磷血症的患者同时口服碳酸钙(钙尔奇D),6个月。观察DCa1.25透析液单次治疗前、后至下一次透析前以及治疗1、2、3、6个月时患者透前血钙(校正的血清总钙)、血磷、iPTH水平(检测采用放免法)。结果:使用DCa1.25透析液单次透析4小时后血钙浓度下降,透后血iPTH(221.3±67)pg/ml较透前(163.7±78)pg/ml明显升高(P<0.05),至下次透析前血钙浓度及血iPTH(163.9±101.1)pg/ml基本恢复至上次透析前水平。使用低钙透析液透析1、2、3、6个月后,患者血钙水平呈下降趋势,在低钙透析2个月时,血钙水平显著低于治疗前水平(2.925±0.25)mmol/l,达(2.55±0.25)mmol/l,P<0.05,这种趋势持续至治疗6个月时,血钙水平(2.6±0.2)mmol/l,P<0.05。低钙透析对患者的iPTH水平有明显的影响,呈上升趋势,在低钙透析3个月时,差异有统计学意义,血iPTH上升至(294.4±134.1)pg/ml(P<0.05),低钙透析治疗6个月时,血iPTH达(295.5±192.3)pg/ml(P<0.05),所有患者均完成了6个月的临床观察,其中6名患者因治疗后的iPTH升高超过300pg/ml,而开始应用活性维生素D,有1例患者iPTH升高达821pg/ml,接受了活性维生素D的冲击治疗。血磷水平在进行低钙透析治疗后有所上升,但差异无统计学意义。结论:在维持性血液透析患者中,单次应用DCa1.25的透析液进行透析,透析后血iPTH升高,但至下一次透析前血iPTH基本恢复至上次透前水平。持续应用低钙透析6个月,钙负荷减轻,血iPTH升高。
Objective：To observe the change of intact parathyroid hormone,serum calcium and serum phosphorus in hemodialysis （HD） patients treated with the dialysate of low-calcium （1.25 mmol/1） for 6 months.Methods：Sixteen patients with hypercalcaemia per-or post-dialysis 3 times per week were enrolled in this study.All of them received hemodialysis with the dialysate of low-calcium （1.25 mmol/1） for 6 months.During this period,the patients maintained stablely for diet.Before and after using the low-calcium dialysate therapy, the serum calcium,phosphorus and intact parathyroid hormone were measured in pre-,post- and the next pre-dialysis.Results：For a single dialysis ,the serum calcium decreased in post-dialysis （2.805±0.2）mmol/1 compared with in pre-dialysis（2.925±0.25）mmol/1,and the iPTH increased significantly in post-dialysis compared with pre-dialysis [（221.3±67）pg/ml,vs （163.7±78）pg/ml,P〈0.05].However, the serum calci-um （2.93±0.24）mmol/1 and iPTH （163.9±101）pg/ml come back in the next pre-dialysis.When patients being dialyzed with the low-calcium dialysate （1.25mmol/1） for 6 months, the serum calcium decreased and the iPTH increased significandy in post-dialysis compared with pre-dialysis [（295.5±192.3）pg/ml vs （163.7±78）pg/ml,P〈0.05].Conclusion：When patients were dialyzed with the dialysate of low-calcium for 6 months, the serum iPTH might increase and the calaium decreased.The iPTH,calcium and phosphorus should be detected regularly if the low calcium dialysate （1.25mmol/l） was used for a long time.
出处
《现代医药卫生》
2006年第22期3417-3419,共3页
Journal of Modern Medicine & Health
关键词
血液透析
低钙透析液
钙磷代谢
Hemodialysis
Low-calcium dialysate
Calcium phosphours metabolism
