秦登优,田恩,祁海峰,孙宝山,吴丽
QIN dengyou,TIAN En,QI Haifeng,SUN Baoshan,WU Li

• 1:重庆医科大学附属第三医院泌尿疾病中心
• 2:陆军军医大学第三附属医院重症医学科
• 3:沈阳医学院附属中心医院重症医学科
• 4:湛江市中心医院肾内科

摘要(Abstract)：

目的:探讨碳酸镧对非糖尿病维持性血液透析(MHD)患者血管钙化的疗效。方法:194例非糖尿病维持性血液透析的患者,随机分为对照组(n=96)和观察组(n=98),对照组进行血液透析,观察组在对照组基础上服用碳酸镧咀嚼片;治疗前、治疗后3个月和6个月时清晨空腹静脉采血5 m L,用日立全自动生化分析仪检查两组患者钙和磷浓度、血红蛋白、肝功总胆固醇、血清肌酐、三酯甘油、LDL、HDL及血脂,化学发光法检测甲状旁腺激素,自动放射免疫分析法测定免疫反应性甲状旁腺激素(i PTH);治疗前、治疗后3个月和6个月时行X线检查,对图像进行钙化评分;治疗6个月后,采用电化学发光法检测骨转换标志物I型前胶原羧基端前肽(PICP)、Ⅰ型胶原羧基端肽交联(β-CTX)及血清基质γ-羟基谷氨酸蛋白(MGP)。结果:观察组与对照组患者治疗后3个月和6个月时,血磷、血钙、钙磷复合物、i PTH水平和血管钙化评分与治疗前比较均有所降低,且观察组血磷、血钙、钙磷复合物、iPTH水平和血管钙化评分均低于对照组,差异有统计学意义(P<0.05);观察组患者治疗6个月时血管钙化评分与同组治疗前评分相比降低,差异有统计学意义(P<0.05);观察组治疗6个月时PICP、β-CTX高于对照组,差异有统计学意义(P<0.05);观察组治疗6个月血清MGP低于对照组,差异有统计学意义(P<0.05)。结论:碳酸镧可以降低血清磷、钙磷复合物和iPTH水平,减轻患者的血管钙化。
Objective: To investigate the effect of lanthanum carbonate( LC) on vascular calcification in patients with non-diabetic maintenance hemodialysis( MHD). Methods: 194 MHD patients were randomly divided into the control group( n = 96) and the experimental group( n = 98). The control group was given hemodialysis( HD),and the observation group took Lanthanum Carbonate Chewable Tablets based on the control group. 5 m L of fasting venous blood samples was collected before treatment and 3 months and 6 months after treatment. Calcium and phosphorus concentrations,hemoglobin,liver function total cholesterol( TC),serum creatinine,triglyceride( TG),LDL,HDL and blood lipids were measured with Hitachi automatic biochemical analyzer. The parathyroid hormone was measured by chemiluminescence,and immunoreactive parathyroid hormone( i PTH) was measured by automated radioimmunoassay. X-ray examination was performed before and 3 months and 6 months after treatment,and the calcification score was made by two radiologists. After 6 months of treatment,electrochemiluminescence was used to detect the bone turnover markers( BTMs) : the carboxy-terminal propeptide of type I procollagen( PICP),βcross-linked C-telopeptide of type 1 collagen( β-CTX) and serum matrix γ-hydroxy glutamic acid protein( MGP). Results: The serum phosphorus,serum calcium,calcium and phosphorus complexes,i PTH levels,and vascular calcification scores were decreased in the observation group and the control group at 3 months and 6 months after the treatment. The serum phosphorus,serum calcium,calcium and phosphorus complexes,i PTH levels,and vascular calcification scores in the observation group were lower than those of the control group. The difference was statistically significant( P < 0. 05). In the observation group,the vascular calcification score at the 6 th month after treatment was lower than that of the same group before the treatment,and the difference was statistically significant( P < 0. 05). In the observation group,PICP and β-CTX were higher than those in the control group at 6 months of treatment( P < 0. 05). The serum MGP in the observation group was lower than that in the control group at the 6 th month after treatment( P < 0. 05). Conclusion: Lanthanum carbonate can reduce serum phosphorus,calcium and phosphorus complexes and i PTH levels,and reduce vascular calcification in patients.

关键词(KeyWords)： 血液透析;碳酸镧;血管钙化;血清;治疗效果
maintenance hemodialysis;lanthanum carbonate;vascular calcification;serum;treatment effect

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 秦登优,田恩,祁海峰,孙宝山,吴丽
QIN dengyou,TIAN En,QI Haifeng,SUN Baoshan,WU Li

DOI: 10.19367/j.cnki.1000-2707.2018.07.027

参考文献(References)：

• [1]徐利鸳,刘毅,吴秀娟,等.维持性血液透析患者的血管钙化情况及危险因素分析[J].医学研究杂志,2012,41(4):95-98.
• [2]张淑芳,梁震,张红梅,等.维持性血液透析患者血管钙化危险因素分析[J].华北理工大学学报(医学版),2016,18(4):294-296.
• [3]吴芳,徐海洋,李彬.维持性血液透析患者应用碳酸镧干预高磷血症的疗效[J].宁夏医科大学学报,2016,38(12):1392-1394.
• [4]RAMKRISHNAN K,BOND T C,CLAXTONA,et al.Clinical characteristics and outcomes of end-stage renal disease patients with self-reported pruritus symptoms[J].Int J Nephrol Renovasc Dis,2014,7:1-12.
• [5]ZANGENEH F,CLARKR B L,Hurley D L,et al.Chronic kidney disease-mineral and bone disorders(CKDMBDs):what the endocrinologist needs to know.Endocr Pract,2014,20(5):500-516.
• [6]涂曦文,彭佑铭,唐东兴,等.维持性血液透析患者血管钙化及相关因素分析[J].中国动脉硬化杂志,2015,23(6):613-615.
• [7]HOSHINA M,WADA H,SAKAKURA K,et al.Determinants of progression of aortic valve stenosis and outcome of adverse events in hemodialysis patients[J].J Cardiol,2012,59(1):78-83.
• [8]MOHAMMED I A,HUTCHISON A J.Phosphate binding therapy in dialysis patients:focus on lanthanum carbonate[J].Ther Clin Risk Manag,2008,4(5):887-893.
• [9]ZHAI C J,YU X S,SUN Q L,et al.Effect of lanthanum car-bonate versus calcium based phosphate binders in dialysis patients:a meta-analysis[J].Clinical Nephrology,2014,82(12):372-378.
• [10]CRIQUIr M H,KAMINENIA,ALLISON M A,et al.Risk factor differences for aortic versus coronary calcified atherosclerosis:the multiethnic study of atherosclerosis[J].Arterioscler Thromb Vasc Biol,2010,30(11):2289-2296.
• [11]KETTELER M,BIGGAR P H.Use of phosphate binders in chronic kidney disease[J].Curr Opin Nephrol Hypertens,2013,22(4):413-420.
• [12]张春华,崔太根,赵素梅,等.碳酸镧对非糖尿病维持性血液透析患者血管钙化的影响[J].中国血液净化,2015,14(6):353-355.
• [13]王芳,吴姝焜,洪大情.糖尿病与非糖尿病血液透析患者矿物质及骨异常的比较分析[J].实用医院临床杂志,2014,11(5):121-123.

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