血液透析患者应用低钙透析液的临床研究(1)
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[摘要] 目的：探讨维持性血液透析患者如何应用低钙透析液。方法：将43例试验前长期应用1.25 mmol/L低钙透析液的维持性血液透析患者随机分入试验组(T组)(20例)和对照组(C组)(23例)。根据入组时血全段甲状旁腺激素(intact parathyroid hormone，iPTH)水平<500 ng/L或≥500 ng/L，T组和C组又分别分为T1组(9例)、T2组(11例)和C1组(15例)、C2组(8例)。入组后T组改用1.50 mmol/L钙浓度血液透析液，C组继续应用1.25 mmol/L钙浓度血液透析液。分别在入组时和入组6个月后检测T组和C组透析前血iPTH水平、血钙及血磷水平，计算钙磷乘积，并进行入组前后和组间的比较。结果：T1组的血iPTH水平有下降的趋势，但与入组前比较差异无统计学意义(P>0.05)；T1组的血钙、血磷及钙磷乘积水平与入组前比较变化均不明显(P>0.05)。T2组的血iPTH水平显著下降(P<0.01)，血磷水平也有明显下降(P<0.05)；而T2组的血钙和钙磷乘积水平无变化(P>0.05)。C1组和C2组的血iPTH水平、血钙、血磷及钙磷乘积水平与入组前比较差异均无统计学意义(P>0.05)。结论：对于伴中重度继发性甲旁亢(iPTH水平≥500 ng/L)、血钙正常或偏低的血液透析患者，长期应用1.25 mmol/L钙浓度透析液可能加重甲状旁腺功能亢进。这类患者选择1.50 mmol/L钙浓度的血液透析液有利于降低血iPTH水平，还可降低血磷水平，而不会升高血钙水平。
[关键词] 血液透析；低钙透析液；钙浓度
[中图分类号] R457 [文献标识码] A [文章编号] 1673-7210(2011)11(c)-054-03
Clinical research of low-calcium dialysate in hemodialysis
GUO Qi, ZHANG Hong, SUN Jing, WANG Xuemei, WANG Yujun, PAN Hong, WANG Rong, WANG Qun
Department of Nephrology, Shandong Provincial Hospital Affiliate to Shandong University, Shandong Province, Ji′nan 250012, China
[Abstract] Objective: To investigate how to use low calcium dialysate in hemodialysis patients. Methods: 43 maintenance hemodialysis patients who had used 1.25 mmol/L calcium dialysate longer than 6 months were divided into test group (T group) and control group(C group). According to different iPTH level, T group were divided into T1(iPTH<500 ng/L) and T2 (iPTH≥500 ng/L) subgroups and C group were divided into C1(iPTH<500 ng/L) and C2 (iPTH≥500 ng/L) subgroups. Then the patients of T group changed to used 1.50 mmol/L calcium dialysate and the patients of C group continued to use 1.25 mmol/L calcium dialysate for six months. The variety of serum iPTH, Ca, P, Ca×P were compared. Results: Six months later, iPTH of T1 subgroup decreased slightly, but there were no significant difference(P>0.05). There were no significant variety of iPTH, Ca , P and Ca×P for T1 subgroup (P>0 ......
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