【摘要】 目的 探讨生理钙透析液对持续性不卧床腹膜透析（CAPD）患者钙磷代谢的影响。 方法 回顾性分析2008年1月-2009年12月腹膜透析患者的钙磷指标，资料齐全的患者中使用钙浓度为1.25 mmol/L的腹膜透析液（生理钙组）的患者有30例，使用钙浓度为1.75 mmol/L的透析液（标准钙组）患者30例。对两组患者钙磷代谢指标进行比较。 结果 治疗前后两组的血磷、钙磷乘积和全段甲状旁腺素差异均无统计学意义（Pgt;0.05）；治疗后标准钙组血钙较前升高，差异有统计学意义（Plt;0.05），而生理钙组治疗前后血钙差异无统计学意义（Pgt;0.05）。 结论 不同含钙浓度腹膜透析液对机体钙磷代谢的影响是不同的，在高钙、高磷、低转运骨病的腹膜透析患者中使用钙浓度为1.25 mmol/L的生理钙透析液减轻了钙负荷，为临床医生使用含钙磷结合剂提供了治疗空间。【Abstract】 Objective To investigate the effects of physiological calcium dialysate on the calcium and phosphorus metabolism in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods We retrospectively analyzed the clinical data of 60 patients having undergone CAPD in West China Hospital of Sichuan University between January 2008 and December 2009. The patients were divided into two groups with 30 in each by calcium concentration of the dialysate: the physiological calcium dialysate group (1.25 mmol/L) and the standard calcium dialysate group (1.75 mmol/L). The metabolism indexes of calcium and phosphorus for the two group of patients were compared. Results Levels of Serum phosphate, calcium-phosphate product and immoreactive parathyroid hormone (iPTH) of all the patients in both groups before and after treatment showed no significant differences (Pgt;0.05). Serum calcium increased significantly in patients treated with standard calcium dialysate (Plt;0.05), while it did not change significantly in patients treated with physiological calcium dialysate (Pgt;0.05). Conclusions Dialysate with different concentrations of calcium provides different influence on the metabolism of calcium and phosphorus. Changing calcium concentration to 1.25 mmol/L in the dialysate can lower the calcium load for patients with hypercalcium and/or hyperphosphate with low bone turnover, providing treatment space for clinical doctors to use binders containing both calcium and phosphorus.
Objective To study the influence of calcium acetate tablets combined with compound alpha-keto acid on calcium and phosphorus metabolism in maintenance hemodialysis (MHD) patients. Methods A total of 112 MHD patients with hyperphosphatemia treated between May 2014 and May 2015 were included in this study. Based on random number table method, they were divided into calcium acetate group (n=37), compound alpha-keto acid group (n=36) and combined drug use group (n=39). All the patients were given a low protein diet. Twelve weeks after treatment, we compared the calcium and phosphorus metabolic indexes, nutrition indicator levels and adverse reactions within and across the three groups. Results Before treatment, there was no significant difference among the three groups in terms of serum calcium, phosphorus, calcium-phosphorus product, and parathyroid hormone (PTH) level (P>0.05). After treatment, the combined drug use group had significantly lower levels of serum phosphorus, calcium-phosphorus product and PTH than the other two groups (P<0.05). Before treatment, the levels of creatinine, serum total protein and albumin were not significantly different among the three groups (P>0.05). After treatment, the serum total protein and albumin level in the combined drug use group were significantly higher than those in the other two groups (P<0.01). Three was no significant difference among the three groups in terms of adverse reactions (P>0.05). Conclusions For MHD patients with hyperphosphatemia, the combined use of calcium acetate tablets and compound alpha-keto acid is better than the use of single drugs, which can effectively improve patients’ symptoms and reduce the level of serum phosphorus with high security. It is worthy of clinical recommendation.