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    施小俊, 陈天浩, 万华, 崇晓凤. 小剂量骨化三醇联合碳酸司维拉姆对血液透析病人慢性肾脏病-矿物质和骨异常的影响[J]. 蚌埠医科大学学报, 2023, 48(4): 482-485. DOI: 10.13898/j.cnki.issn.1000-2200.2023.04.015
    引用本文: 施小俊, 陈天浩, 万华, 崇晓凤. 小剂量骨化三醇联合碳酸司维拉姆对血液透析病人慢性肾脏病-矿物质和骨异常的影响[J]. 蚌埠医科大学学报, 2023, 48(4): 482-485. DOI: 10.13898/j.cnki.issn.1000-2200.2023.04.015
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    SHI Xiao-jun, CHEN Tian-hao, WAN Hua, CHONG Xiao-feng. Effects of low-dose calcitriol combined with sevelamer carbonate on chronic kidney disease-mineral and bone abnormalities in hemodialysis patients[J]. Journal of Bengbu Medical University, 2023, 48(4): 482-485. DOI: 10.13898/j.cnki.issn.1000-2200.2023.04.015
    Citation: SHI Xiao-jun, CHEN Tian-hao, WAN Hua, CHONG Xiao-feng. Effects of low-dose calcitriol combined with sevelamer carbonate on chronic kidney disease-mineral and bone abnormalities in hemodialysis patients[J]. Journal of Bengbu Medical University, 2023, 48(4): 482-485. DOI: 10.13898/j.cnki.issn.1000-2200.2023.04.015
    shu

    小剂量骨化三醇联合碳酸司维拉姆对血液透析病人慢性肾脏病-矿物质和骨异常的影响

    Effects of low-dose calcitriol combined with sevelamer carbonate on chronic kidney disease-mineral and bone abnormalities in hemodialysis patients

      摘要
    • 摘要:
      目的探究小剂量骨化三醇联合碳酸司维拉姆对维持性血液透析(maintenance hemodialysis, MHD)病人慢性肾脏病-矿物质和骨异常(CKD-MBD)的影响。
      方法选取84例MHD病人作为研究对象, 采用随机数字表法将其分为对照组和观察组各42例。给予对照组病人血液透析治疗和碳酸司维拉姆口服, 观察组病人在此基础上联合小剂量骨化三醇口服, 持续治疗2个月。观察并比较2组病人治疗前及治疗2个月后临床疗效、超敏C反应蛋白(hs-CRP)、血磷、血钙和血清全段甲状旁腺激素(iPTH)水平、腹主动脉钙化(AAC)积分及不良反应发生情况。
      结果持续治疗2个月后, 观察组总有效率88.10%高于对照组的69.05%(P < 0.05);对照组和观察组病人治疗1个月及2个月后血清hs-CRP、血磷、iPTH水平比治疗前明显降低, 血钙水平明显提高(P < 0.05~P < 0.01), 且观察组血清hs-CRP、血磷、血钙和iPTH水平均低于对照组(P < 0.05~P < 0.01);治疗后观察组和对照组AAC积分均有所提高(P < 0.01), 但观察组提高幅度低于对照组(P < 0.01);观察组不良反应总发生率7.14%与对照组的11.90%差异无统计学意义(P>0.05)。
      结论MHD病人在常规治疗的基础上联合应用小剂量骨化三醇和碳酸司维拉姆能够有效降低血磷和iPTH水平, 改善微炎症状态, 延缓血管钙化, 提高治疗效果, 安全性良好。

       

      Abstract:
      ObjectiveTo explore the effect of low-dose calcitriol combined with sevelamer carbonate on chronic kidney disease-mineral and bone abnormalities (CKD-MBD) in patients undergoing maintenance hemodialysis (MHD).
      MethodsA total of 84 patients with MHD were selected as the research objects, and they were divided into the control group and observation group using a random number table method, with 42 cases in each group.Patients in the control group were given hemodialysis treatment and oral sevelamer carbonate, and the patients in the observation group were given oral administration of low-dose calcitriol on this basis for 2 months.The clinical efficacy, high-sensitivity C-reactive protein (hs-CRP), blood phosphorus, blood calcium and serum parathyroid hormone (iPTH) levels, abdominal aortic calcification (AAC) point before and 2 months after treatment, and the occurrence of adverse reactions were observed and compared.
      ResultsAfter 2 months of continuous treatment, the total effective rate of the control group was 69.05%, which was higher than that of the observation group 88.10% (P < 0.05).The serum hs-CRP, phosphorus, and iPTH levels of the control group and the observation group were significantly lower than those before treatment, and the blood calcium level was significantly increased (P < 0.05 to P < 0.01).The serum hs-CRP, phosphorus, calcium and iPTH levels of the observation group were significantly lower than those of the control group (P < 0.01).After treatment, the AAC scores of the observation group and the control group were significantly increased, which of and the observation group was significantly lower than the control group (P < 0.01).The total incidence of adverse reactions in the observation group was 7.14%, the total incidence of adverse reactions in the control group was 11.90 %, and there was no significant difference between the two groups (P>0.05).
      ConclusionsCombined application of low-dose calcitriol and sevelamer carbonate in MHD patients on the basis of conventional treatment can effectively reduce blood phosphorus and iPTH levels, improve the micro-inflammatory state, delay vascular calcification, and improve the therapeutic effect.It has good safety.

       

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