慢性肾脏疾病患者钙磷代谢的控制对血管钙化的影响

目的观察慢性肾脏疾病（chronickidneydisease，CKD）3期开始纠正钙磷代谢紊乱对患者血管钙化的影响。方法选择本院门诊或住院的CKD3～4期非透析患者80例，按随机数字表法分为干预组及观察组，每组40例。干预组进行钙磷代谢紊乱严格干预，观察组则给予CKD的常规治疗，观察并比较2组患者的血压、血尿素氮、血肌酐、血钙、血磷、全段甲状旁腺素（intactparathyroidhor—mone，iPTH）、血红蛋白（hemoglobin，Hb）、血白蛋白等指标，同时通过腹部、骨盆、手部x线平片进行血管钙化的定量测量。结果2组治疗后的血钙、血磷、钙磷乘积、iPTH、收缩压（systolicbloodpressure，SBP）和血白蛋白较治疗前明显变化，而舒张压（diastolicbloodpressure，DBP）和Hb较治疗前无明显变化（P〉O．05）。干预组血钙治疗后高于治疗前（P〈O．05），亦高于对照组（P〈O．05）；干预组和观察组血磷和血白蛋白治疗前相比均升高，但观察组升高更显著（P〈0．05）。干预组和观察组血SBP和iFrrH与治疗前相比均降低，但干预组降低更显著（P〈O．05）。干预组发生血管钙化4例，观察组发生血管钙化10例，干预组血管钙化的发生率低于观察组（P〈O．05）。结论钙磷代谢紊乱参与了CKD血管钙化的进展，在CKD3期开始干预可明显延缓其进展，提高患者预后质量。

Effects of controlling calcium and phosphorus metabolism on vascular calcification early in patients with chronic kidney disease

Objective To observe the effect of early intervention in calcium and phosphorus me- tabolism from stage 3 on vascular calcification in patients with chronic kidney disease （CKD）. Methods Eightynon-dialysis patients were selected in our hospital outpatient or hospitalization at sta- ges 3 and 4, and randomly divided into intervention group and control group. The patients in interven- tion group were given strict intervention on calcium and phosphorus metabolism. The blood pressure （SBP,DBP）, blood urea nitrogen, creatinine, serum calcium（Ca）, phosphorus （P）, intact parathyroid hormone（iPTH）, hemoglobin, and serum albumin were observed. Vascular calcification was quantita- tively evaluated by plain radiographic films from abdomen, pelvis and hands. Results After the treat- ment,Ca, P,Ca x p, iPTH, SBP and Alb changed more significantly than before treatment, while there was no significant difference in DBP and Hb before and after treatment（P〈0. 05）. Serum Ca level in control group after treatment was significantly higher than that before treatment（P〈0. 05）, and sig- nificantly higher in intervention group than in control group（P〈0. 05）. Blood P and Alb in interven- tion group were significantly increased as compared with control group（P〈0. 05）. Blood SBP and iPTH in intervention group were significantly lower than in control group before and after treatment（P 〈0. 05）. Incidence of carotid artery calcification in intervention group was significantly lower than in control group（P〈0. 05）. Conclusions Calcium and phosphorus metabolism is involved in the progression of vascular calcification in CKD. The intervention at the CKD stage 3 can significantly delay the progress,and improve the prognosis.