低钙透析联合高通量透析对钙磷代谢及营养状态的影响

目的观察低钙透析液联合高通量透析（HFHD）对尿毒症伴矿物质及骨代谢异常患者钙磷代谢及营养状态的影响。方法选择2009年1月至2009年12月我院维持性血液透析（MHD）患者23例，所有患者血钙处于正常高值或高钙血症或高钙磷乘积且血清全段甲状旁腺素（iPTH）水平升高，观察前所有患者使用钙离子浓度为1．5mmol／L的透析液和FreseniusF6透析器。将23例患者随机分为2组。A组12例，换用FreseniusF60高通量透析器；B组11例，继续使用FreseniusF6透析器。所有患者均换用钙离子浓度为1．25mmol／L的透析液，共观察12周。比较2组血钙、血磷、钙磷乘积、iPTH、血红蛋白（Hb）、血浆白蛋白（Alb）、前白蛋白（PAB）、超敏C反应蛋白（hs-CRP）、白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、肱三头肌皮皱厚度（TSF）和上臂中段肌肉周径（MAMC）。结果与观察前相比，A组观察后血钙、血磷、钙磷乘积、iPTH降低（P〈0．01），Hb、Alb、PAB升高（P〈0．05），hsCRP、IL-6、TNF-α降低（P〈0．01），TSF升高（P〈0．01），MAMC有升高趋势，但差异尚无统计学意义（P〉0．05）；B组血钙降低（P〈0．01），其余各项指标无差异（P〉0．05）。观察后，A组血钙、钙磷乘积、iPTH低于B组（P〈0．01），血磷及IL-6亦低于B组（P〈0．05）。无一例患者出现低血压及肌肉痉挛。结论低钙透析液联合HFHD可改善尿毒症伴矿物质及骨代谢异常患者钙磷代谢及营养状态。

Effect of low calcium dialysate with high-flux hemodialysis on calcium and phosphate metabolism and nutritional status

Objective To observe the effect of low calcium dialysate with high-flux hemodialysis （HFHD） on calcium and phosphate metabolism and nutritional status in uremic patients with mineral and bone disorder（MBD）. Methods Twelve patients received low calcium dialysate with high-flux he- modialysis （group A）while eleven patients received low calcium dialysate with hemodialysis（group B） for a period of 12 weeks. Serum concentration of calcium, phosphate, intact parathyroid hormone （iPTH） ,hemoglobin（Hb）, albumin（Alh）, prealbumin（PAB） .high sensitivity C-reactive protein（hs- CRP）. interleukin-6 （ II.-6 ）. tumor necrosis factor -α （TNF-α） and triceps skin-fold thickness （ TSF）, mid-arm muscle circumference（MAMC） were determined before and 12 weeks after treatment. Results 12 weeks after therapy, serum calcium, phosphate, calcium and phosphate product, iPTH, hs- CRP, IL-6, TNF-α were markedly reduced while Hb, Alb, PAB, TSF were markedly elevated in group A（P~0. 01）. Only serum calcium were reduced in group B（P〈0. 01）. The levels of serum calcium, phosphate, calcium and phosphate product, iPTH , IL-6 were lower in group A than those in group B（P〈0. 05 or P〈0. 01）. No hypotension and spasms due to hypoealcemia happened in both group. Conclusion Low calcium dialysate with HFHD can improve calcium and phosphate metabolism and nutritional status in uremic patients with MBD.