碳酸镧治疗维持性血液透析患者高磷血症的短期疗效及安全性

目的观察碳酸镧治疗维持性血液透析患者高磷血症的短期疗效及安全性。方法选取维持性血液透析并高磷血症患者42例,随机分为两组,每组21例。试验组给予碳酸镧咀嚼片,根据患者的血磷值制定碳酸镧的使用剂量;对照组给予碳酸钙D_3咀嚼片,1片,bid;治疗周期均为12周。观察两组血磷、血钙、钙磷乘积、血全段甲状旁腺素水平变化及不良反应。结果试验组和对照组血磷分别于治疗2周和4周后出现下降,试验组血磷下降幅度大于对照组(P<0.05)。试验组治疗前后血钙水平无明显变化(均P>0.05),对照组治疗后血钙升高(P<0.05)。试验组钙磷乘积下降,且低于同时点对照组,差异显著(P<0.05)。试验组和对照组胃肠道反应发生率分别为29%和24%(P>0.05),高钙血症发生率分别为0和29%(P<0.05)。结论与碳酸钙相比,碳酸镧具有更快、更好的降血磷效果,且不会导致高钙血症,是治疗维持性血液透析患者高磷血症安全有效的药物。

Short-term efficacy and safety of lanthanum carbonate on hyperphosphatemia patients undergoing maintenance hemodialysis

AIM To evaluate the short-term efficacy and safety of lanthanum carbonate in treating maintenance hemodialysis patients with hyperphosphatemia.METHODS Forty-two patients undergoing maintenance hemodialysis were randomly divided into trial group(n = 21) and control group(n = 21).The patients in the trial group were treated with lanthanum carbonate chewable tablets and the dose was adjusted according to the value of phosphatemia.The patients in the control group were treated with calcium carbonate and vitamin D_3 chewable tablets,1 tablet,bid.Treatment period was 12 weeks in each group.The serum levels of phosphorus,calcium,and intact parathyroid hormone were detected and adverse reactions were recorded.RESULTS The significant decline of phosphorus levels were observed after 2 weeks treatment in the trial group and 4 weeks treatment in the control group.Compared with the control group,the descend range of phosphorus was more predominance in the trial group(P < 0.05).The serum level of calcium had no significant change after treatment in the trial group(P > 0.05),while increased in the control group(P < 0.05).The calciumphosphorus product decreased more significantly in the trial group compared with the control group(P < 0.05).The incident rate of gastrointestinal symptoms in trial group and control group was 29%and 24%(P > 0.05),and that of hypercalcemia were 0 and 29%(P < 0.05).CONCLUSION Lanthanum carbonate has the better and faster effect on decreasing phosphorus level,with no hypercalcemia.Lanthanum carbonate is effective and safety in treating hyperphosphatemia in maintenance hemodialysis patients.