碳酸镧联合醋酸钙对维持性血液透析患者钙磷矫正浓度、血管钙化及甲状旁腺功能的影响

目的 探讨碳酸镧咀嚼片联合醋酸钙片对维持性血液透析（MHD）患者血钙矫正浓度、血磷浓度、钙磷乘 积、血管钙化情况及甲状旁腺功能的影响。方法 选取2017年9月—2018年9月本院收治的90例MHD患者作为受 试对象，根据随机数字表法分为对照组45例和研究组45例。对照组口服醋酸钙片治疗，研究组在对照组基础上口 服碳酸镧咀嚼片治疗，2组均连续治疗12周。评价临床疗效，比较治疗前后2组血钙矫正浓度、血磷浓度、钙磷乘积、 冠脉钙化积分（CACS）及血清甲状旁腺激素（PTH）等浓度。结果 治疗后，研究组总有效率显著高于对照组 （93.33% vs. 75.56%，P＜0.05）。治疗后2组患者血钙矫正浓度均显著高于治疗前，血磷浓度及钙磷乘积均明显低于 治疗前（P＜0.05），且治疗后研究组血钙矫正浓度、血磷浓度及钙磷乘积均明显低于对照组（P＜0.05）。治疗后2组 患者CACS、血清PTH浓度均显著低于治疗前，且研究组患者CACS、血清PTH浓度明显低于对照组（P＜0.05）。2组 患者药物不良反应发生率差异无统计学意义（P＞0.05）。结论 碳酸镧咀嚼片和醋酸钙片联合治疗效果好，不仅能 有效纠正MHD患者钙、磷代谢异常，延缓血管钙化进展，还可明显改善甲状旁腺功能。

Effects of lanthanum carbonate and calcium acetate on calcium and phosphorus correction concentrations,vascular calcification and parathyroid function in maintenance hemodialysis patients

Objective To investigate the effects of lanthanum carbonate chewable tablets combined with calcium acetate tablets on the serum calcium correction concentration, phosphorus concentration, vascular calcification and parathyroid gland function in maintenance hemodialysis (MHD). Methods Ninety patients with MHD admitted to our hospital from September 2017 to September 2018 were selected as subjects. According to the random number table method, 90 patients with MHD were divided into control group (45 cases) and study group (45 cases). The patients in the control group were treated with calcium acetate tablets and the patients in the study group were treated with lanthanum carbonate chewable tablets on the basis of the control group. Both groups were treated continuously for 12 weeks. The clinical efficacy was evaluated. The serum calcium correction concentration, phosphorus concentration, coronary artery calcification score (CACS) and serum parathyroid hormone (PTH) concentration were compared before and after treatment between the two groups. Results After treatment, the total effective rate was significantly higher in the study group than that of the control group (93.33% vs. 75.56%, P＜0.05). After treatment, the serum calcium correction concentration was significantly higher than that before treatment in both groups, and the serum phosphorus concentration and calcium-phosphorus product were significantly lower than those before treatment (P＜0.05). After treatment, the serum calcium correction concentration, the serum phosphorus concentration and calcium-phosphorus product were significantly lower in the study group than those in the control group (P＜0.05). After treatment, the levels of CACS and PTH were significantly lower than those before treatment in both groups (P＜0.05). The concentration of CACS and serum PTH was significantly lower in the study groupthan that in the control group (P＜0.05). There was no significant difference in the incidence of adverse drug reactions between the two groups (P＞0.05). Conclusion Lanthanum carbonate chewable tablets combined with calcium acetate tablets can effectively correct the abnormal metabolisms of calcium and phosphorus in MHD patients, delay the progress of vascular calcification and significantly improve the function of parathyroid gland.