维生素 D、非含钙的磷结合剂与含钙的磷结合剂对慢性肾脏病患者血管钙化进展的影响

【目的】探讨维生素 D、非含钙的磷结合剂与含钙的磷结合剂对慢性肾脏疾病患者血管钙化进展的影响。【方法】随机选取本院自2010年1月至2014年12月收治的78例慢性肾脏病患者作为研究对象,按就诊顺序编号,参照随机数字表法分为 A、B 两组,每组39例,均采用维生素 D 治疗,A 组在此基础上加用非含钙的磷结合剂碳酸镧治疗,B组则采用常规含钙的磷结合剂醋酸钙治疗,比较治疗前后两组血钙、血磷、钙磷乘积、全段甲状旁腺激素(iPTH)水平的变化,比较两组维生素 D、钙磷结合剂使用情况,配合影像学检查评估患者冠脉钙化积分(CACs)的变化,统计治疗期间不良事件发生率。【结果】①治疗后,两组血磷、钙磷乘积、iPTH 水平均较治疗前明显降低,但两组间相比较差异无显著性(P >0.05),A 组血钙水平降低至(2.24±0.17)mmol/L,降低幅度高于 B 组,两组相比较差异有显著性(P <0.05)；②A 组磷结合剂摄入量为(1719.21±410.22)mg/d,明显低于 B 组的(4913.34±1332.26)mg/d,两组相比较差异有显著性(P <0.05)；③B 组中重度钙化分别占20.51%、10.26%,均高于 A 组(P <0.05)；④A 组不良事件发生率为10.26%,明显低于 B 组的48.72%,两组相比较差异有显著性(P <0.05)。【结论】在慢性肾脏病血管钙化的防治中,采用维生素 D联合非含钙的磷结合剂碳酸镧干预,血钙控制效果好,不良事件发生率低,可延缓患者血管钙化进展。

Examination of the Effect of Vitamin D,Non-Calcium Phosphate Binders,and Calcium Phosphate ;Binders on the Progress of Vascular Calcification in Patients with Chronic Kidney Disease

Objective]To analyze the effect of vitamin D,non-calcium phosphate binders,and calcium phosphate binders on the progress of vascular calcification in patients with chronic kidney disease.[Methods]Seventy-eight cases of patients with chronic kidney disease treated in our hospital from January 2010 to December 2014 were randomly selected as the research ob-jects.According to the order of admission,the patients were numbered and,with reference to the random number table meth-od,divided into two Groups,A and B,with 39 cases in each group.All of the patients were treated with vitamin D.Patients in group A were also treated with non-calcium phosphate binder (lanthanum carbonate),while patients in group B were also treated with routine calcium phosphate binder (calcium acetate).The changes in blood calcium,serum phosphorus,calcium-phosphorus product,and intact parathyroid hormone (iPTH)levels were compared between the two groups before and after the treatment.The use of vitamin D and phosphorus binder in the two groups was compared.Imaging examinations showed the changes in coronary artery calcium score (CACs),which were evaluated and statistically analyzed along with the incidence rates of adverse events during the treatment.[Results]①After the treatment,serum phosphorus,calcium-phosphorus prod-uct,and iPTH levels in the two group decreased significantly,but the differences between groups were not statistically signifi-cant (P >0.05).Blood calcium level in group A was reduced to(2.24±0.17)mmol/L and the decreased amplitude was higher than that in Group B (P <0.05);② The intake of phosphorus binder of Group A [(1719.21±410.22)mg/d]was signifi-cantly lower than that of Group B [(4913.34±1332.26)mg/d](P <0.05).③ Moderate and severe calcification in Group B accounted for 20.51% and 10.26%,respectively,which were higher than the amounts they accounted for in Group A (P <0.05).④ The incidence of adverse events in Group A (10.26%)was significantly lower than that in Group B (48.72%)(P<0.05).[Conclusion]In the treatment and prevention of vascular calcification in patients with chronic kidney disease,adopting vitamin D combined with non-calcium phosphate binders (lanthanum carbonate)intervention results in a good effect in the blood calcium control,and the incidence of adverse events is low.It can slow down the progression of vascular calcification.