碳酸镧对维持性血液透析患者高磷血症的疗效及安全性被引量：11

Therapeutic effect and safety of lanthanum carbonate on hyperphosphatemia in maintenance hemodialysis patients

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摘要目的探讨碳酸镧对维持性血液透析患者高磷血症治疗的有效性和安全性。方法采用多中心、队列研究方式,选择符合纳入标准的维持性血透患者60例,将其分为2组,每组30例,分别使用碳酸镧或醋酸钙进行降磷治疗,观察时间为8周,定期检测各项血生化指标,记录不良反应。结果治疗前,两组透析患者血磷、血钙水平比较差异无统计学意义(P>0.05),治疗结束时,两组血磷水平均降低(P<0.05)。但治疗后2、4、8周,碳酸镧组血磷水平均低于醋酸钙组(P<0.05),血磷水平达标率(<1.78 mmol/L)高于醋酸钙组(P<0.05)。治疗结束时,碳酸镧组血钙水平与治疗前比较差异无统计学意义(P>0.05),而醋酸钙组血钙水平升高(P<0.05)。碳酸镧组的各期发生高钙血症比率及累计不良反应发生率均低于醋酸钙组(P<0.05)。结论相较于常用含钙磷结合剂醋酸钙,碳酸镧对于维持性血液透析患者具有更好的降磷效果,且高钙血症的发生率降低,可避免增加血管钙化的风险,且不增加患者的不良反应。 Objective To explore the effectiveness and safety of lanthanum carbonate in the treatment of hyperphosphatemia in patients with maintenance hemodialysis. Methods Sixty patients with maintenance hemodialysis who met the inclusion criteria were selected by multi-center and cohort study. All the patients were divided into lantha- num carbonate group and calcium acetate group according to different treatment drugs the patients used, 30 cases in each group, and the observation time was 8 weeks. The blood biochemical indicators were detected and the adverse reac- tions were recorded. Results There was no significant difference in the serum levels of phosphorus and calcium be- tween the two groups before treatment （P 〉 0. 05 ）. However, the blood phosphorus levels of patients decreased at the end of the treatment （ P 〈 0. 05 ）. The serum phosphorus levels in lanthanum carbonate group were lower than those of calcium acetate group at 2,4 and 8 weeks after treatment （ P 〈 0. 05 ） , and the standard-reaching rate of serum phos- phorus levels （〈 1.78 mmol/L） was higher （P 〈 0. 05 ）. There was no significant difference in serum calcium level in lanthanum carbonate group before and after treatment （ P 〈 0. 05 ）, which increased in calcium acetate group （ P 〈 0. 05 ）. The rates of hypercalcemia and the accumulative adverse reactions in lanthanum carbonate group were lower than those of calcium acetate group （ P 〈 0. 05 ）. Conclusion Compared to the commonly used calcium and phosphate binders-calcium acetate, lanthanum carbonate can reduced the serum phosphorus in patients with maintenance hemodial- ysis with low incidence of hypercalcemia, and avoid the risk of vascular calcification and decrease the adverse reactions of patients.