活性炭联合小麦纤维素颗粒辅助控制慢性肾衰竭血液透析患者高磷血症的疗效观察

摘要

目的：观察活性炭联合小麦纤维素颗粒对常规治疗未能控制的血液透析患者高磷血症的治疗作用。方法采用单中心、前瞻性、自身前后对照研究。经含钙的磷结合剂等常规治疗后仍存在高磷血症的血液透析患者，予以药用活性炭片0.9g与三餐同服，小麦纤维素颗粒3.5g/次，2次/d，根据腹泻和便秘情况调整小麦纤维素颗粒剂量。治疗3个月。检测治疗前后血磷、钙、全段甲状旁腺激素（iPTH）、白蛋白、血红蛋白水平。用配对t检验进行统计学分析。结果与治疗前比较，治疗3个月后患者血磷水平显著下降[（1.78±0.32）mmol/L比（2.28±0.24）mmol/L，P<0.01]；血钙磷乘积也相应显著下降[（53.35±6.23）mg2/dl2比（64.25±6.46）mg2/dl2，P<0.01]；血钙及iPTH水平差异无统计学意义（P>0.05）。活性炭治疗后血白蛋白及血红蛋白水平与治疗前比较差异无统计学意义（P>0.05）。治疗过程中出现腹泻4例、便秘2例，经调整小麦纤维素颗粒剂量均缓解。结论活性炭联合小麦纤维素颗粒可协助治疗血液透析患者高磷血症，为高磷血症的控制提供一条新途径，有更多并发继发性甲状旁腺功能亢进症的患者可以接受活性维生素D的治疗，其对血钙、iPTH、白蛋白及血红蛋白水平无明显影响。%ObjectiveTo research the eficacy of activated carbon combined with wheat cellulose particles in refractory hyperphosphatemia in patients on hemodialysis.MethodsA single-center,prospective,self-controlled study was performed.Patients on hemodialysis with hyperphosphatemia that could not be successfully controlled by Calcium-based phosphate binders,who received activated carbon 0.9g with meal three times per day and wheat cellulose particles 3.5g two times per day for three months.Dose of wheat cellulose particles was increased or decreased depending on patients,gastrointestinal symptoms.The levels of serum phosphorus,calcium,calcium-phosphorus products,intact parathyroid hormone(iPTH),albumin and hemoglobin were detected before and after the treatment. The results were analyzed using paired t-test.ResultsAfter 3 months of treatment,thepatients,serum phosphorus level was significantly reduced from(2.28±0.24)mmol/L(pretreatment)to(1.78±0.32) mmol/L(post-treatment)(P<0.01).Similarly,the serum calcium-phosphorus products were low ered from pretreatment level of(64.25±6.46) mg2/dl2 to post-treatment level of(53.35±6.23)mg2/dl2(P<0.01). there were no significant changes in serum calcium、iPTH、albumin and hemoglobin levels w hen compared pretreatment to post-treatment values(P>0.05).ConclusionsActivated carbon combined with wheat cellulose particles is effective as an adjuvant measure in control of hyperphosphatemia in patients on hemodialysis,and provides a new approach for the treatment of hyperphosphatemia,which has no significant influence on serum calcium,iPTH,albumin and hemoglobin levels. There are more patients with hyperparathyroidism who can receive treatment of vitamin D.