维持性血液透析患者钙磷代谢紊乱及碳酸钙对血钙磷和iPTH的影响

目的了解维持性血液透析（血透）患者的钙磷代谢情况、全段甲状旁腺激素（iPTH）水平及碳酸钙对血钙磷、iPTH的影响。方法检测42例血透患者血钙磷、iPTH水平，选择血磷〉1．78mmol／L的患者服用碳酸钙12周，观察治疗前后血钙、磷、钙磷乘积及iPTH的变化。结果①在42例患者中，经白蛋白校正过的平均血清总钙水平为（2．30±0．31）mmol／L（1．50～2．83）mmol／L]，其中低钙血症（〈2．10mmol／L）者有8例（19％），高钙血症（〉2．37mmol／L）12例（29％）；平均血磷水平为（2．20±0．85）mmol／L【（1．21～3．84）mmol／L】，其中高磷患者23例（55％）；平均钙磷乘积（60．00±18．16）mf／dl^2（31．02～97．56）mg^2／dL^2】，钙磷乘积〈55mg^2／dL^2的患者有15例（36％）；平均iPTH水平为（330．15±262．92）ng，L【（40．8～1322）ng／L]，其中〈100ng／L者5例（12％），（100～300）ng／L者15例（36％），〉300ng／L者22例（52％）。②服用碳酸钙后，血钙明显升高（P〈0．05），血磷、钙磷乘积及iPTH均明显下降（P〈0．05）。结论维持性血透患者普遍存在钙磷代谢紊乱及继发性甲状旁腺功能亢进症，碳酸钙对高磷血症及继发性甲状旁腺功能亢进症有治疗作用，但需注意高钙血症的发生。

Analysis of the Calcium and Phosphorus Metabolism Disorders in Maintenance Hemodialysis Patients and Investigate the Influence of Calcium Carbonate on the Serum Calcium, Phosphorus and iPTH

Objective To observe the metabolism of calcium and phosphorus and the level of intact parathyroid hormone （ iPTH ） in the maintain hemodialysis patients, and then investigate the influence of calcium carbonate on the serum calcium, phosphorus and iPTH. Methods Serum calcium and phosphorus and level of iPTH of 42 hemodialysis patients were analyzed. Then the patients whose serum phosphorus 〉 1.78 mmol/L were orally administrated calcium carbonate for 12 weeks. Serum calcium, phosphorus, calciumphosphorus product and iPTH were observed. Results ① The average of serum calcium was （ 2.30 ± 0.31 ） mmol/L （ 1.50-2.83 mmol/ L ）. There were 8 patients with hypocalcemia and 12 patients with hypercalcinemia. The average of serum phosphorus was （ 2.20 ± 0.85 ） mmol/L （ 1.21-3.84 mmol/L ）. Hyperpho-sphatemia occurred in 23 patients （ 55% ）. The average of calcium-phosphorus product was （ 60.00 ± 18.16 ） mg2/dL2 （ 31.02-97.56 mg2/dL2 ）. The levels of calcium-phosphorus product were lower than 55 mg2/dL2 in 15 patients. The average of iPTH was （ 330.15 ±262.92 ） ng/L （ 40.8-1322 ng/L ）. The levels of iPTH were lower than 100 ng/L in 5 patients （ 12% ） and higher than 300 ng/L in 22 patients （ 52% ）. ②After 12 weeks of treatment, serum calcium was markedly elevated （ P 〈 0.05 ）. The iPTH, serum phosphorus and calcium phosphorus product significantly declined （P 〈 0.05 ）. Conclusion Disorders of calcium and phosphorus metabolism, secondary hyperpara-thyroidism are common in the maintain hemodialysis patients. Calcium carbonate plays an important role in hyperphosphatemia and secondary hyperparathyroidism. But we should attend hypercalcemia.