碳酸司维拉姆治疗维持性透析患者高磷血症的有效性和安全性

 目的 评价碳酸司维拉姆治疗维持性血液透析(MHD)合并高磷血症的有效性和安全性。方法 选取2017-05至2018-01陆军总医院MHD合并高磷血症患者共81例,随机分为试验组和对照组,两组在常规治疗基础上分别应用碳酸司维拉姆(n＝39)和醋酸钙(n＝42)进行治疗,观察6个月,记录两组患者血磷、血钙、钙磷乘积、甲状旁腺激素(iPTH)及低密度脂蛋白水平,同时记录不良反应。结果 (1)试验组治疗后2、4、6个月血清磷明显降低(P＜0.05),对照组治疗后4、6个月明显降低(P＜0.05)。两组间对比,试验组在治疗2个月时水平低于对照组(P＜0.05)。(2)试验组治疗2、4、6个月时血清钙水平无明显变化,对照组治疗4、6个月时较治疗前有所增加(P＜0.05),试验组在治疗6个月时水平低于对照组(P＜0.05)。(3)试验组在治疗2、4、6个月后钙磷乘积水平明显下降(P＜0.05),对照组在治疗6个月后水平较治疗前下降(P＜0.05),试验组在治疗6个月时水平低于对照组(P＜0.05)。(4)两组治疗后iPTH水平均显著降低(P＜0.05)。(5)试验组低密度脂蛋白在治疗6个月后较治疗前明显降低(P＜0.05),对照组治疗6个月后无明显变化。(6)两组间不良反应发生率无统计学差异。结论 碳酸司维拉姆能安全有效地用于治疗维持性透析患者高磷血症,并且在降低钙磷乘积和低密度脂蛋白方面和醋酸钙相比有一定优势。

Efficacy and safety of sevelamer carbonate against hyperphosphatemia in maintenance hemodialysis patients

Objective To evaluate the efficacy and safety of sevelamer carbonate in the treatment of maintenance hemodialysis (MHD) patients with hyperphosphatemia. Methods Eigyty-one MHD patients treated in the Army General Hospital between May 2017 and January 2018 were enrolled in this study. They were divided into two groups.The treatment group (n=39) received sevelamer carbonate for 6 months while the control group (n=42) received calcium acetate. The therapeutic effect was evaluated according to the changes of serum phosphorus, calcium, calcium-phosphate products, iPTH and LDL-C. The adverse effect was recorded simultaneously. Results (1) After treatment, levels of serum phosphorus decreased significantly at 2, 4 and 6 months (P<0.05) in the treatment group, but at 4 and 6 months in the control group(P<0.05). Two months after treatment, these levels in the treatment group were lower than those of the control group (P<0.05). (2) There was no significant change in serum calcium levels at 2, 4, and 6 months after treatment in the treatment group, but they were increased in the control group at 4 and 6 months after treatment (P<0.05). Compared with the control group, the serum calcium level in the treatment group was lower at 6 months after treatment (P<0.05). (3) Calcium and phosphorus levels were significantly decreased (P<0.05) after 2, 4 and 6 months of treatment in the treatment group, but after 6 months of treatment in the control group (P<0.05). They were lower in the treatment group than in the control group after 6 months of treatment (P<0.05).(4) iPTH levels decreased significantly after treatment in both groups (P<0.05). (5)Low density lipoprotein in the experimental group decreased significantly after 6 months of treatment (P<0.05), but there was no significant change after 6 months of treatment in the control group. (6)There was no significant difference in the incidence of adverse reactions between the two groups. Conclusions Sevelamer carbonate is safe and effective in treating hyperphosphatemia in patients with maintenance dialysis, and has the advantage of reducing the level of calcium-phosphorus products and low density lipoprotein compared with calcium acetate.