摘要
目的 通过观察动力缺失性骨病的腹膜透析患者使用低钙透析液提高全段甲状旁腺激素（iPTH）治疗动力缺失性骨病的有效性和安全性以及对钙磷代谢的影响.方法 选取动力缺失性骨病患者（iPTH＜100 ng/L）22例,改用百特（Baxter）PD4（Ca 1.25 mmol/L）透析液治疗,回顾分析9个月血iPTH、血钙、血磷、血钙磷乘积及血白蛋白等指标.结果 使用低钙透析液治疗后,第一个月血iPTH水平明显上升[治疗前vs 1月（52.34±33.49）ng/Lvs.（117.66±63.16）ng/L,P＜0.05],第3、6、9月逐步上升,并保持在安全范围内.iPTH水平上升至100～300 ng/L的患者所占比例在第1、3、6、9个月分别为50%、62.5%、63.5%、63.5%.治疗后第一个月血钙水平由治疗前（2.56±0.23）mmol/L下降至（2.25±0.20）mmol/L（P=0.01）;血磷水平由治疗前的（1.66±0.48）mmol/L降至（1.47±0.41）mmol/L（P＜0.05）;血钙磷乘积值由治疗前的52.20±14.29下降至40.79±11.38（P＜0.01）.平均血钙、血磷、血钙磷乘积值在后8个月中均保持稳定.血钙磷乘积值在第1、3、6、9个月达到目标值（＜55）的比例分别为73.33%,77.78%,82.35%,85%,与治疗前（50%）比较,P值均＜0.05.治疗前后血清白蛋白无明显差异.治疗中没有明显低钙抽搐、低血压等情况发生.结论 对动力缺失性骨病的腹膜透析患者使用低钙透析液能有效地调整其iPTH水平以治疗动力缺失性骨病,并且安全性好,同时能有效地控制血钙、血磷及钙磷乘积水平.
Purpose The purpose of the present study was to investigate the effectiveness and safety of low calcium dialysate in ABD patients undergoing continuous ambulatory peritoneal dialysis （CAPD）. Methods Twenty-two CAPD patients with PTH〈100 ng/L received low calcium dialysate （Baxter PD4 with calcium concentration 1.25 mmol/L） for a period of 9 months. In the same time,calcium bicarbonate or renagel was given to control the plasma phosphorus level. Level of serum iPTH,calcium, phosphorus, and albumin were retrospective analyzed. Results After changing to PD4,iPTH increased significantly in the first month [baseline vs 1 month： （52.34 ± 33.49） ng/L vs （117.66 ± 63.16） ng/L,P〈0.0], and increased gradually in month 3,6, and 9. The percentages of patients whose serum iPTH level reached to target range （100-300 ng/L） in month 1,3,6,9 were 50 %, 62.5 % ,63.5 % ,63.5 %, respectively. After changing to PD4 for 1 month, serum calcium level declined from （2.56 ± 0.23） mmol/L to （2.25 ± 0.20） mmol/L （P = 0.01）, serum phosphorus level declined from （1.66 ± 0.48） mmol/L to （1.47 ± 0.41） mmol/L （P〈0.05） ,serum calcium-phosphorus product level declined from （52.20 ± 14.29） to （40.79 ± 11.38） （P〈0.01）. The mean level of serum calcium,phosphorus and calcium-phosphorus product changed slightly in the following 8 months. The percentages of patients whose serum calcium-phosphorus product level reached to target range （〈55） in baseline and month 1,3,6,9 were 50% ,73.33% ,77.78% ,82.35% ,85%, respectively. There was no significant change in albumin level during treatment. The majority of patients tolerated low calcium dialysate well,no hypotension and no hyperspasmia appeared. Conclusions The low calcium dialysate can effectively increase iPTH level to the target range and thus be used to treat ABD;meanwhile,it can ameliorate the calcium and phosphate metabolism.
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2007年第2期213-215,222,共4页
Fudan University Journal of Medical Sciences
关键词
动力缺失性骨病
甲状旁腺激素
低钙透析液
钙磷代谢
腹膜透析
adynamic bone disease
parathormone
low-calcium dialysate
calcium-phosphate metabolism
peritoneal dialysis
