透析液钙离子浓度对维持性血液透析患者血全段甲状旁腺激素的影响

目的评价不同钙离子浓度的透析液对维持性血液透析(MHD)患者血全段甲状旁腺激素(iPTH)的影响,分析血钙、磷和钙磷乘积与iPTH之间的相关性。方法对2006年1月至3月,上海交通大学医学院附属新华医院肾内科门诊35例长期使用钙离子浓度为1·75mmol/L的透析液进行维持性血液透析的患者,于透析前留取血标本进行血Ca2 、P3-、iPTH测定,并计算钙磷乘积后,改为钙离子浓度为1·25mmol/L或1·50mmol/L的透析液进行维持性血液透析,3个月后于透析前再次留取血标本进行血Ca2 、P3-、iPTH测定,并计算钙磷乘积。结果与使用钙离子浓度为1·75mmol/L透析液比较,使用钙离子浓度为1·25mmol/L或1·50mmol/L透析液3个月后,MHD患者血Ca2 、P3-、钙磷乘积差异无显著性意义,P>0·05,血iPTH明显升高,P<0·01。血iPTH与Ca2 呈显著性负相关,r=-0·45,P<0·01;与P3-及钙磷乘积无相关性,r分别为0·13和-0·03,均P>0·05。结论1·25mmol/L或1·50mmol/L的低钙透析液可以升高MHD患者血清iPTH水平。

Effects of dialysate calcium concentrations on serum iPTH in maintenance hemodialysis patients

Objective To evaluate the effects of different calcium concentrations in dialysate on serum intact parathyroid hormone(iPTH)in maintenance hemodialysis(MHD)patients and analyze the relativities between the serum Ca2 ,P3-,product of calcium-phosphorus and iPTH.Methods Thirty-five MHD patients with 1.75 mmol/L calcium dialysate were measured serum Ca2 ,P3-,iPTH before hemodialysis,and product of calcium-phosphorus was calculated.Then they were given 1.25 mmol/L or 1.50 mmol/L calcium dialysate to dialyse.After three months,measure serum Ca2 ,P3-,iPTH before hemodialysis and calculate product of calcium-phosphorus again.Results After using 1.25 mmol/L or 1.50 mmol/L calcium dialyste for three months,the serum Ca2 ,P3- and product of calcium-phosphorus of the MHD patients showed no significant difference,P>0.05,compared with using 1.75 mmol/L calcium dialysate.The serum iPTH increased significantly,P<0.01.Serum iPTH had significant negative relativity with serum Ca2 ,r=-0.47,P<0.01,and no relativities with P3-and product of calcium-phosphorus,r=0.04 and r=0.08 respectively,P>0.05.Conclusion 1.25 mmol/L or 1.50 mmol/L lower-calcium dialysate can elevate the level of serum iPTH in MHD patients.