醋酸钙联合碳酸镧治疗尿毒症血液透析高磷血症的疗效观察

目的探讨醋酸钙片联合碳酸镧咀嚼片治疗尿毒症血液透析患者高磷血症的临床疗效。方法选取2014年8月—2016年9月在青岛市市立医院进行尿毒症血液透析高磷血症患者134例,根据血磷水平随机分为醋酸钙组(43例)、碳酸镧组(45例)、醋酸钙和碳酸镧联合组(46例)。醋酸钙组口服醋酸钙片,2片/次,3次/d;碳酸镧组口服碳酸镧咀嚼片,2片/次,3次/d;联合组口服碳酸镧咀嚼片、醋酸钙片,2片/次,3次/d。3组患者均持续治疗12周。观察各组的临床疗效,比较各组的观察指标。结果碳酸镧组总有效率(75.5%)高于醋酸钙组(69.7%),但差异无统计学意义。联合组总有效率(94.5%)高于醋酸钙组、碳酸镧组,差异均具有统计学意义(P0.05)。治疗后,各组血磷、血甲状旁腺素(PTH)均显著降低,碳酸镧组血钙、冠状动脉钙化积分(CACs)降低,醋酸钙组、联合组血钙、CACs升高,与同组治疗前比较差异具有统计学意义(P0.05)。治疗后,与醋酸钙组比较,碳酸镧组、联合组的血磷、血钙、血PTH、CACs均降低,差异具有统计学意义(P0.05);与碳酸镧组比较,联合组的血磷、血PTH降低,血钙、CACs升高,差异具有统计学意义(P0.05)。结论碳酸镧和醋酸钙均能有效降低血磷,但碳酸镧对血钙的影响较小,并能明显延缓CACs的进展。碳酸镧联合醋酸钙控制血磷效果最好,但有增加CAC的进展的风险,有待于进一步研究。

Clinical observation of alcium acetate combined with lanthanum carbonate in treatment of hyperphosphatemia in patients with uremic hemodialysis

Objective To explore the clinical effect of Calcium Acetate Tablets combined with Lanthanum Carbonate Chewable Tablets in treatment of hyperphosphatemia in patients with uremic hemodialysis. Methods Patients (134 cases) with uremic hemodialysis in Qingdao Municipal Hospital (Group) from August 2014 to September 2016 were enrolled in this study. According to the serum phosphorus level, patients were divided into calcium acetate group (43 cases), lanthanum carbonate group (45 cases), and combine treatment group (46 cases). The patients in the calcium acetate group were po administered with Calcium Acetate Tablets, 2 tablets/time, three times daily. The patients in the lanthanum carbonate group were po administered with Lanthanum Carbonate Chewable Tablets, 2 tablets/time, three times daily. The patients in the combination group were po administered with Calcium Acetate Tablets and Lanthanum Carbonate Chewable Tablets, 2 tablets/time, three times daily. Patients in three groups were treated for 12 weeks. After treatment, the clinical efficacies were evaluated, and observation indexes among groups were compared. Results After treatment, the clinical efficacies in the calcium acetate and lanthanum carbonate groups were 75.5% and 69.7%, respectively, but clinical efficacy (94.5%) in the combination group were higher than those in two groups, and there was difference between two groups (P<0.05). After treatment, the levels of serum phosphorus and serum PTH were decreased, and serum calcium and CACs in lanthanum carbonate group were decreased, but the serum calcium level and calcium in calcium acetate group and combination group were increased, and the difference was statistically significant in the same group (P<0.05). After treatment, the levels of blood phosphorus, blood PTH, serum calcium and CACs in lanthanum carbonate group and combination group were higher than those in calcium acetate group, and the differences were statistically significant (P<0.05). Compared with lanthanum carbonate group, the levels of blood phosphorus and PTH were decreased, but blood calcium and CACs were increased in lanthanum carbonate group, the differences were statistically meaning (P<0.05). Conclusion Lanthanum carbonate or calcium acetate has clinical curative effect in treatment of hyperphosphatemia in patients with uremic hemodialysis, can significantly reduce the levels of serum phosphorus, but lanthanum carbonate has little effects on calcium and can delay the progress of CACs. The effect of calcium carbonate combined with calcium acetate are the best on the control of serum phosphorus, but the risk of the development of CAC is increased, which is worthy of further discussion.