• 四川大學華西醫(yī)院腎臟內科（成都，610041）;

【摘要】　目的　 探討生理鈣透析液對持續(xù)性不臥床腹膜透析（CAPD）患者鈣磷代謝的影響。　方法　 回顧性分析2008年1月-2009年12月腹膜透析患者的鈣磷指標，資料齊全的患者中使用鈣濃度為1.25 mmol/L的腹膜透析液（生理鈣組）的患者有30例，使用鈣濃度為1.75 mmol/L的透析液（標準鈣組）患者30例。對兩組患者鈣磷代謝指標進行比較。　結果　 治療前后兩組的血磷、鈣磷乘積和全段甲狀旁腺素差異均無統(tǒng)計學意義（P gt;0.05）；治療后標準鈣組血鈣較前升高，差異有統(tǒng)計學意義（P lt;0.05），而生理鈣組治療前后血鈣差異無統(tǒng)計學意義（P gt;0.05）。　結論　 不同含鈣濃度腹膜透析液對機體鈣磷代謝的影響是不同的，在高鈣、高磷、低轉運骨病的腹膜透析患者中使用鈣濃度為1.25 mmol/L的生理鈣透析液減輕了鈣負荷，為臨床醫(yī)生使用含鈣磷結合劑提供了治療空間。
【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 (P gt;0.05). Serum calcium increased significantly in patients treated with standard calcium dialysate (P lt;0.05), while it did not change significantly in patients treated with physiological calcium dialysate (P gt;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.

引用本文： 仉超,王瑩瑩,張艷玲,唐曉紅,秦敏. 腹膜透析患者鈣磷代謝紊亂臨床分析. 華西醫(yī)學, 2011, 26(3): 335-337. doi: 復制

1. 　Johnson RJ, Feehally J. Comprehensive clinical nephrology[M]. Philadelphia: Hacourt Publishers, 2000: 1-11.
2. 　Holgado R, Haire H, Ross D, et al. Effect of a low calcium dialysate on parathyroid hormone secretion in diabetic patients on maintenance hemodialysis[J]. J Bone Miner Res, 2000, 15(5): 927-935.
3. 　Goodman WG, Goldin J, Kuizon BD, et al. Coronary artery calcification in young adults with end-stage renal disease who are undergoing dialysis[J]. N Eng J Med, 2000, 342(20): 1478-1483.
4. 　Brandi L, Melsen PK, Bro S, et al. Long-term effects of intermittent oral alphacalcidol, calcium carbonate and low-calcium dialysis, (1.25 mmol/L) on secondary hyperparathyroidism in patients on CAPD[J]. J Inter Med, 1998, 244(2): 121-131.
5. 　Amstrong A, Beer J, Noonan, et al. Reduced calcium dialysate in CAPD patients: efficacy and limitations[J]. Nephrol Dial Transplant, 1997, 12(6):1223-1228.
6. 　Young EW, Albert JM, Satayathum S, et. al. Predictors and consequences of altered mineral metabolism: the dialysis out comes and practice patterms study[J]. Kidney Int, 2005, 67(3): 1179-1187.
7. 　Bloek GA, Hulbert-Shearon TE, Levin NW, et al. Association of serum phosphorus and caleium x phosphate product with mortality risk in chronic hemodialysis patients: a national study[J]. Am J Kidney Dis, 1998, 31(4): 607-617.
8. 　Levin NW, Hulberg-shearron TE, Straderman RL, et al. Which causes of death are related to hyperphosphatemia in hemodialysis patients[J]. J Am Soc Nephrol, 1998, 9: 217A.
9. 　Bender F, Bernardini J, Piraino B. Calcium mass transfer with dialysate containing 1.25 and 1.75 mmol/L calcium in peritoneal dialysis patients[J]. Am J Kidney Dis, 1992, 20(4): 367-371.
10. 　Qunibi W, Moustafa M, Muenz LR, et al. A 1-year randomized trial of calcium acetate versus sevelamer on progression of coronary artery calcification in hemodialysis patients with comparable lipid control: the calcium acetate renagel evaluation-2 (CARE-2) study[J]. Am J Kidney Dis,2008, 51(6): 952-965.
11. 　林愛武, 錢家琪, 龐慧華, 等. 長期使用低鈣透析液對腹膜透析患者鈣磷代謝的影響[J]. 中華腎臟病雜志, 2005, 21(12): 713-715.
12. 　Argile′s A, Mourad G. How do we have to use the calcium in the dialysate to optimize the management of secondary hyperparathyroidism?[J]. Nephrol Dial Transpl, 1998, 13(Suppl 3): 62-64.
13. 　Eknoyan G, Levin A, Levin NW, et al. Bone metabolism and disease in chronic kidney disease[J]. Am J Kidney Dis, 2003, 42(Suppl 3): 7-201.
  1. 1. 　Johnson RJ, Feehally J. Comprehensive clinical nephrology[M]. Philadelphia: Hacourt Publishers, 2000: 1-11.
  2. 2. 　Holgado R, Haire H, Ross D, et al. Effect of a low calcium dialysate on parathyroid hormone secretion in diabetic patients on maintenance hemodialysis[J]. J Bone Miner Res, 2000, 15(5): 927-935.
  3. 3. 　Goodman WG, Goldin J, Kuizon BD, et al. Coronary artery calcification in young adults with end-stage renal disease who are undergoing dialysis[J]. N Eng J Med, 2000, 342(20): 1478-1483.
  4. 4. 　Brandi L, Melsen PK, Bro S, et al. Long-term effects of intermittent oral alphacalcidol, calcium carbonate and low-calcium dialysis, (1.25 mmol/L) on secondary hyperparathyroidism in patients on CAPD[J]. J Inter Med, 1998, 244(2): 121-131.
  5. 5. 　Amstrong A, Beer J, Noonan, et al. Reduced calcium dialysate in CAPD patients: efficacy and limitations[J]. Nephrol Dial Transplant, 1997, 12(6):1223-1228.
  6. 6. 　Young EW, Albert JM, Satayathum S, et. al. Predictors and consequences of altered mineral metabolism: the dialysis out comes and practice patterms study[J]. Kidney Int, 2005, 67(3): 1179-1187.
  7. 7. 　Bloek GA, Hulbert-Shearon TE, Levin NW, et al. Association of serum phosphorus and caleium x phosphate product with mortality risk in chronic hemodialysis patients: a national study[J]. Am J Kidney Dis, 1998, 31(4): 607-617.
  8. 8. 　Levin NW, Hulberg-shearron TE, Straderman RL, et al. Which causes of death are related to hyperphosphatemia in hemodialysis patients[J]. J Am Soc Nephrol, 1998, 9: 217A.
  9. 9. 　Bender F, Bernardini J, Piraino B. Calcium mass transfer with dialysate containing 1.25 and 1.75 mmol/L calcium in peritoneal dialysis patients[J]. Am J Kidney Dis, 1992, 20(4): 367-371.
  10. 10. 　Qunibi W, Moustafa M, Muenz LR, et al. A 1-year randomized trial of calcium acetate versus sevelamer on progression of coronary artery calcification in hemodialysis patients with comparable lipid control: the calcium acetate renagel evaluation-2 (CARE-2) study[J]. Am J Kidney Dis,2008, 51(6): 952-965.
  11. 11. 　林愛武, 錢家琪, 龐慧華, 等. 長期使用低鈣透析液對腹膜透析患者鈣磷代謝的影響[J]. 中華腎臟病雜志, 2005, 21(12): 713-715.
  12. 12. 　Argile′s A, Mourad G. How do we have to use the calcium in the dialysate to optimize the management of secondary hyperparathyroidism?[J]. Nephrol Dial Transpl, 1998, 13(Suppl 3): 62-64.
  13. 13. 　Eknoyan G, Levin A, Levin NW, et al. Bone metabolism and disease in chronic kidney disease[J]. Am J Kidney Dis, 2003, 42(Suppl 3): 7-201.