不同钙浓度透析液对血透患者颈动脉粥样硬化的影响

目的探讨低钙透析液（钙1.25mmol/L）、标准钙透析液（钙1.5mmol/L）对血液透析患者颈动脉粥样硬化的影响。方法选择64例维持性血液透析（MHD）合并颈动脉粥样硬化,随机分成对照组和治疗组。其中对照组接受标准钙透析液（钙1.5mmol/L）、治疗组;治疗组接受低钙透析液透析,透析当天晚餐中均嚼服碳酸钙600毫克。检测指标为检测血钙、血磷、血甲状旁腺素（PTH）水平、彩色多普勒超声检测颈动脉粥样硬化相关指标测定。具体为每位患者每1个月测血磷、血钙,每2个月测血甲状旁腺激素,每3个月行颈动脉超声检查,观察颈动脉内膜厚度及斑块情况,共观察1年,并总结不同钙浓度透析液对血液透析患者颈动脉粥样硬化的影响。结果对照组血钙和血磷水平逐步上升,12个月时检测值与初始值比较有显著差异（P〈0.05）;而治疗组血钙和血磷水平有所下降,但12个月时检测值与初始值比较差异不存在统计学意义（P〉0.05）。12个月时两组间血钙和血磷水平比较差异具有统计学意义（P〈0.05）。治疗组患者iPTH均值有下降趋势,但12个月时检测值与初始值比较差异没有统计学意义（P〉0.05）;而对照组患者iPTH降低,12个月时检测值与初始值比较差异存在统计学意义（P〈0.05）。两组患者内中膜厚度（mm）、斑块例数（例）均出现改善,其中12个月时检测值与初始值比较差异存在统计学意义（P〈0.05）。而两组组间比较,治疗组两项检查结果的12个月时检测值要显著好于对照组（P〈0.05）。结论较低浓度的钙透析液有助于解决异位血管钙化,延缓粥样硬化进展。

The clinical effect of different calcium dialysate on hemodialysis patients with carotid artery atherosclerosis

【Objective】 To investigate the efficacy of hemodialysis patients with carotid atherosclerosis treated with low calcium dialysate（1.25mmol/L calcium） or the standard calcium dialysate（1.5mmol/L calcium）.【Methods】 64 patients with maintenance hemodialysis（MHD） patients were randomly divided into control group and treatment group.The control group were treated with standard calcium dialysate（1.5mmol/L calcium）,low calcium dialysate（1.25mmol/L calcium）;the treatment group were low calcium dialysate dialysis and 600 mg calcium carbonate.The patients were ditected serum calcium,phosphorus,parathyroid hormone（PTH）,and measured color Doppler ultrasound of carotid atherosclerosis.They were treated and observed 1 year.【Results】 In control group,the level of serum calcium,phosphorus and iPTH were significantly different between the start and the end（P0.05）;but in the treatment group,there were not significant difference between them（P0.05）.And having been treated for 12 months,the serum calcium and phosphorus levels between the two groups was statistically significant difference（P0.05）.The thickness（mm）,plaque the number of cases（cases） of all patients were improved but treatment group were significantly better than the control group（P0.05）.【Conclusion】 The low concentration of calcium dialysate can improve the ectopic vascular calcification,and delay the happen of atherosclerosis progression.