司維拉姆與碳酸鈣D3調節慢性腎衰竭血液透析患者鈣磷水平的有效性及安全性觀察

張青 彭衛平 歐陽奮競

[摘要] 目的 觀察司維拉姆與碳酸鈣D3調節慢性腎衰竭維持性血液透析（maintenance hemodialysis MHD）患者鈣磷水平的有效性及安全性。 方法 選取2018年6月～2019年4月本院血液透析中心慢性腎衰竭MHD治療患者70例，根據口服降磷藥物不同分為觀察組和對照組各35例，觀察組予碳酸司維拉姆片降磷，對照組予碳酸鈣D3片降磷，觀察期間兩組均根據血磷水平變化調整降磷藥物用量，觀察療程均6個月。比較兩組患者治療前后血磷、血鈣、鈣磷乘積、全段甲狀旁腺激素（immunoreactive parathyroid hormone，iPTH）水平，兩組總有效率及藥物不良反應發生率。 結果 觀察組總有效率明顯高于對照組，差異有統計學意義（P<0.05）。兩組治療后血磷、鈣磷乘積、iPTH均低于治療前，差異有統計學意義（P<0.05）。治療后觀察組血磷、鈣磷乘積、iPTH水平明顯低于對照組，差異有統計學意義（P<0.05）。兩組治療后血鈣均低于治療前，但差異無統計學意義（P>0.05）。治療后觀察組血鈣低于對照組，但差異無統計學意義（P>0.05）。兩組不良反應發生率比較，差異無統計學意義（P>0.05）。 結論 碳酸鈣D3與司維拉姆均可有效調節血磷水平，降低MHD患者高磷血癥，改善鈣磷代謝紊亂，且司維拉姆療效較碳酸鈣D3更明顯，兩組均未發生嚴重不良反應，安全性好，適宜臨床推廣應用。

[關鍵詞] 司維拉姆;碳酸鈣D3;慢性腎衰竭;血液透析;高磷血癥

[中圖分類號] R692.5 ? ? ? ? ?[文獻標識碼] B ? ? ? ? ?[文章編號] 1673-9701（2020）12-0050-04

[Abstract] Objective To observe the effectiveness and safety of sevelamer and calcium carbonate D3 in regulating calcium and phosphorus levels in maintenance hemodialysis patients with chronic renal failure. Methods 70 MHD patients with chronic renal failure treated in our hospital's hemodialysis center from June 2018 to April 2019 were selected. They were divided into observation group and control group，with 35 patients in each group. The observation group was given phosphorus reduction by sevelamer carbonate. And the control group was given calcium carbonate D3 tablets to reduce phosphorus. During the observation period，the dosage of dephosphorization drugs in both groups was adjusted according to changes in blood phosphorus levels，and the observation course was 6 months. The levels of blood phosphorus，blood calcium，calcium-phosphorus product，and total immunoreactive parathyroid hormone（iPTH） before and after treatment were compared between the two groups. The total effective rate and the incidence of adverse drug reactions were compared between the two groups. Results The total effective rate in the observation group was significantly higher than that in the control group，and the difference was statistically significant（P<0.05）. The blood phosphorus，calcium-phosphorus product，and iPTH after treatment were lower in the two groups than those before treatment，and the differences were statistically significant（P<0.05）. After treatment，the blood phosphorus，calcium-phosphate product，and iPTH levels in the observation group were significantly lower than those in the control group， and the differences were statistically significant（P<0.05）.The blood calcium after treatment in both groups was lower than those before treatment，but the difference was not statistically significant（P>0.05）. After treatment，the blood calcium in the observation group was lower than that in the control group，but the difference was not statistically significant（P>0.05）. There was no significant difference in the incidence of adverse reactions between the two groups（P>0.05）. Conclusion Both calcium carbonate D3 and sevelamer can effectively regulate blood phosphorus levels，reduce hyperphosphatemia in patients with MHD，and improve calcium and phosphorus metabolism disorders. The efficacy of sevelamer is more obvious than that of calcium carbonate D3，and no serious adverse reactions occurred in both groups. They have good safety and are suitable for clinical application.

[Key words] Sevelamer; Calcium carbonate D3; Chronic renal failure; Hemodialysis; Hyperphosphatemia

高磷血癥是嚴重影響維持性血液透析患者生活質量的十分常見的并發癥，該癥狀能夠引發甲狀旁腺激素水平升高和腎性骨病，而且是血管與瓣膜鈣化的啟動因子，高血磷、高血鈣以及鈣磷乘積升高均與血管鈣化呈正相關。……