烟酰胺治疗血液透析患者高磷血症的疗效观察

目的观察烟酰胺治疗血液透析患者高磷血症的疗效和安全性。方法30例维持性血液透析患者经停用其他磷结合剂2周后，患者（血磷〉1．5mol／L）每天口服烟酰胺500-750mg，观察8周。分别比较治疗前和治疗后4周和8周患者血磷、血钙、钙磷乘积、碱性磷酸酶、血常规、肝功能、。肾功能和血脂的变化。结果与治疗前相比，烟酰胺治疗4周后血磷水平、钙磷乘积和血全段甲状旁腺素明显下降，8周达到最低水平，8周后碱性磷酸酶明显减低（P〈0．05）。治疗前、后血清钙、白细胞数、肝酶、血糖和血脂均无显著变化。结论烟酰胺可有效控制维持性血液透析患者的高磷血症，降低钙磷乘积和碱性磷酸酶，而且无明显毒副作用。

Safety and efficacy of nicotinamide in the management of hyperphosphatemia in patients subject to hemodialysis

Objective To evaluate the effectiveness and side-effects of nicotinamide for hyper- phosphatemia in patients undergoing hemodialysis. Methods After withdrawal of other phosphate binders for 2 weeks in 30 patients undergoing maintenance hemodialysis, nieotinamide（250 mg） were given orally twice daily for 17 patients with 1.5~2. 5 mmol/L serum phosphorus,and thrice daily for 13 patients with serum phosphorus greater than 2. 5 mmol/L for 8 weeks. Blood samples were tested at baseline,4th week and 8th week. The efficacy and side-effects of nicotinamide were evaluated by the changes from serum phosphate and calcium levels, calcium-phosphorus product, alkaline phosphatase level and complete blood count, blood sugar, renal profile, liver function tests and adverse effects. Results Compared to the baseline, there were significant decreases in the serum phosphate, the serum calcium-phosphorus product and iPTH at the 4th week （P〈0. 05） and 8th week （P〈0. 01）, and alka- line phosphatase levels at the 8th week （P〈0. 05） after treatment with nicotinamide. Other parameters remained unchanged. Conclusions Nicotinamide is safe and effective in controlling serum phosphorus, Ca ×p product and alkaline phosphatase levels in patients undergoing maintenance HD.