低钙透析液联合活性维生素D及盐酸司维拉姆治疗血液透析患者继发性甲状旁腺功能亢进的临床观察

目的 观察低钙透析液联合活性维生素D及盐酸司维拉姆治疗在慢性肾功能衰竭维持性血液透析患者继发性甲状旁腺功能亢进的疗效。方法 收集青海省人民医院肾内科30例慢性肾功能衰竭维持性血液透析患者，采用浓度为1．25mmol／L低钙透析液，联合活性维生素D冲击治疗及口服盐酸司维拉姆应用6个月后观察血清钙、磷、钙磷乘积、血清全段甲状旁腺激素的变化。结果 在治疗3个月及治疗6个月后30例患者血钙治疗前2．34±0．17mmol／l、治疗3个月后2．36±0．2lmmol／l、治疗6个月后2．37±0．20mmol／l，基本维持正常水平；治疗前血磷2．27±0．39mmol／l、治疗3个月后1．75±0．41mmol／l、治疗6个月后1．41±0．35mmol／l；治疗前钙磷乘积63．21±10．13mg^2／dl^2、治疗3个月后53．27±9．57mg^2／dl^2、治疗6个月后48．51±9．74mg^2／dl^2；治疗前甲状旁腺激素650．80±119．40pg／ml、治疗3个月后376．10±117．40pg／ml、治疗6个月后211．90±109．40pg／ml；血磷、钙磷乘积、全血甲状旁腺激素均下降降明显；与治疗前经方差分析比较，血磷治疗3个月后F=1．10，P=4．97×10^-6、治疗6个月F=0．81，P=1．38×10^-12；钙磷乘积治疗3个月后F=0．89，P=0．0002、治疗6个月F=0．92，P=3．79×10^-7；甲状旁腺激素治疗3个月后F=0．97，P=1．40×10^-12、治疗6个月F=0．84，P=2．06×10^-21；差异均有统计学意义（P〈0．05）。治疗过程中出现胃肠道不良反应4例，经处理后缓解。结论 慢性。肾功能衰竭维持性血液透析患者继发性甲状旁腺功能亢进在应用低钙透析液、盐酸司维拉姆、活性维生素D冲击联合治疗后血磷、钙磷乘积及iPTH水平明显降低，避免了高钙血症和转移性钙化的出现，对高转运型肾性骨病起到安全有效的治疗作用。

Effect of low calcium dialysate combined with active vitamin D and sevelamer hydrochloride on secondary hyperparathyroidism in hemodialysis patients

objective To observe the effect of low calcium dialysate combined with active vitamin D and sevelamer hydrochloride on secondary hyperparathyroidism in chronic renal failure patients with maintenance hemodialysis （MHD）. Methods We recruited 30 cases of chronic renal failure patients with MHD treated in the Nephrology Department of Qinghai Province People＇s Hospital using low calcium dialysate （1.25 mmol/ L） combined with pulse treatment of active vitamin D and oral administration of sevelamer hydrochloride. Changes of serum calcium, phosphorus, calcium-phosphorus product, and intact parathyroid hormone （iPTH） were recorded after the treatment for 6 months. Results In the 30 cases before the treatment, after the treatment for 3 months and for 6 months, serum calcium was 2.34±0.17 mmol/L, 2.36±0.21 mmol/L and 2.37± 0.20 mmol/L, respectively, all within the normal serum range; serum phosphate was 2.27±0.39 mmol/L, 1.75± 0.41 mmol/L and 1.41 ±0.35 mmol/L, respectively; calcium-phosphorus product was 63.21± 10.13 mg^2/dl^2, 53.27±9.57 mg^2/dl^2 and 48.51±9.74 mg^2/dl^2, respectively; serum iPTH was 650.80±119.40 pg/ml, 376.10± 117.40 pg/ml and 211.90± 109.40 pg/ml, respectively. As compared with those before the treatment, serum phosphate, calcium-phosphorus product and iPTH decreased after the treatment for 3 months （F=1.10, P= 4.97× 10^-6 for serum phosphate; F=0.89, P=0.0002 for calcium-phosphorus product; F=0.97, P=1.40× 10^-12 for iPTH）, and decreased further after the treatment for 6 months （F=0.81, P=1.38×10^-12 for serum phosphate; F=0.92, P=3.79× 10^-7 for calcium-phosphorus product; F=0.84, P=2.06× 10^-21 for iPTH）. Four patients were found to have adverse gastrointestinal reactions that disappeared after appropriate treatment. Conclusion Dialysis with low calcium dialysate combined with sevelamer hydrochloride and pulse doses of active vitamin D can significantly decrease serum phosphorus and calcium-phosphorus product for secondary hyperparathyroidism in chronic renal