生理钙腹膜透析液对钙磷代谢达标及血管钙化影响的研究

摘要

目的:探讨生理钙腹膜透析对患者钙磷代谢紊乱和心血管钙化的影响.方法:2009年1月至2015年6月在我院规律随访大于12个月的134例腹膜透析患者,根据使用透析液钙离子浓度不同分为高钙透析组、生理钙透析组.比较患者治疗12个月前后的钙磷代谢情况、心脏超声及血管钙化等相关指标.结果:71例高钙透析组患者在治疗12个月后,其血钙水平显著高于使用生理钙透析组的58例患者(P<0.01).高钙透析组患者在治疗12个月后,其血钙、冠脉积分、腹主动脉积分水平较基线水平升高程度显著高于生理钙透析组患者(P<0.05).5例患者随访中由高钙透析液转为生理钙透析液,在更换为生理钙透析液治疗12个月后,患者血钙显著降低、iPTH明显升高(P<0.05).与高钙透析组患者比较,生理钙透析组和高钙转生理钙透析组患者在治疗12个月后,活性维生素D的使用和血钙达标的比例显著高于前者(P<0.05).高钙转生理钙透析液的5例患者在改用生理钙透析液后患者的iPTH达标率显著增加(P<0.05).结论:与高钙透析液相比,使用生理钙透析液有利于维持腹膜透析患者血钙的达标,改善iPTH代谢,并延缓血管钙化的进程.%Objective:To investigate the calcium-phosphorus metabolism and cardiovascular system in patients using physiological calcium peritoneal dialysis fluid .Methods:A total of 134 peritoneal dialysis patients who had been followed-up for more than 12 months were divided into high calcium dialysis group and physiological calcium dialysis group according to the types of dialysate they used .After 12 months of treatment , the general situation , ser-um levels of calcium and phosphorus and the indices of cardiac ultrasound and vascular calcification were compared between the two groups .Results:After 12 months of treatment , the serum calcium level was significantly increased in high calcium dialysis group ( P<0 .01 ) .The increments of serum calcium , calcification scores of coronary arter-ies and abdominal aorta were more prominent in the high calcium dialysis group than those in the physiological cal -cium dialysis group ( P<0.05) .For the 5 patients who had changed their dialysate from high calcium to physical calcium , the 12-month treatment of physical calcium dialysate made their serum calcium significantly decreased and the iPTH level markedly increased ( P<0 .05 ) .As compared with the patients in high calcium group , those in physical calcium group and the five patients who had switched to physical calcium dialysate had a higher proportions of vitamin D administration and a more ideal serum calcium level .After patients replaced their dialysis therapy from high calcium dialysate to physical calcium dialysate , the standard-reaching rate of serum iPTH and calcium in-creased .Conclusions:Physical calcium dialysate are helpful for the patients to maintain ideal serum calcium and improve iPTH variation, and delay the aggregation of vascular calcification .