短期应用碳酸镧对维持性血液透析高磷血症患者的血磷及血FGF23的影响

目的 研究短期使用碳酸镧治疗对终末期肾脏病维持性血液透析（maintenance hemodialysis,MHD）高磷血症患者血清成纤维生长因子-23（fibroblast groth factor-23,FGF23）、Klotho蛋白的影响. 方法 来自北京协和医院血液净化中心12例并发高磷血症（透析前血磷＞1.78 mmol/L）的MHD患者纳入本研究.经过2周磷结合剂洗脱后,根据患者血磷水平予以相应口服剂量的碳酸镧片剂治疗,给药第2周根据患者血清钙磷水平调整药物剂量,疗程为4周,4周后停用碳酸镧继续服用原剂量的碳酸钙1月.总观察期为10周. 结果 12例患者完成全部观察.经碳酸镧治疗4周后,10例患者血磷明显下降,6名患者血磷控制在1.78mmol/L以内（2.33±0.09 mmol/L比1.51±0.06 mmol/L,P=0.003）,4周后停用碳酸镧,继续服用原剂量碳酸钙,1月后复查血磷,9名患者血磷均有所升高（1.76±0.10 mmol/L比2.23±0.10mmol/L,P=0.040）.使用碳酸镧前后及更换碳酸钙1月后12名患者血钙、iPTH无明显变化.12名患者服用碳酸镧后FGF23均有不同程度的下降,停用碳酸镧后使用碳酸钙治疗1月后FGF23水平有明显升高（P＜0.05）.血清α-Klotho蛋白水平在使用碳酸镧治疗后所有患者α-Klotho水平均有明显下降,停用碳酸镧服用碳酸钙1月后α-Klotho水平仍然持续偏低,升高不明显.结论 碳酸镧可有效纠正MHD患者的高磷血症,短期即可降低这些患者血清FGF23水平.

Effects of lanthanum carbonate on serum phosphate and serum FGF23 in maintenance hemodialysis patients with hyperphosphatemia

Objective To evaluate the short-term efficacy of lanthanum carbonate in treating maintenance hemodialysis （MHD） patients with hyperphosphatemia.Methods A single center,open-labeled study from Peking Union Medical College Hospital was performed.Phosphate binders were discontinued during a two-week washout period.Patients with more than 1.78 mmol/L serum phosphorus after two-week washout period were eligible for the study.The dose was adjusted after first two weeks as necessary to achieve lower serum phosphorus.Lanthanum carbonate was administered to 12 MHD patients for 4 weeks,followed by taking the original dose of calcium carbonate for 4 weeks.Results All patients fulfilled the whole study.After 4 weeks of treatment with lanthanum carbonate,serum phosphorus decreased significantly in 10 patients,and serum phosphorus was controlled to less than 1.78 mmol/L in 6 patients （2.33±0.09 vs.1.51±0.06 mmol/L,P=0.003）.After continued use of the original dose of calcium carbonate for 4 weeks,serum phosphorus increased in 9 patients （1.76±0.10 vs.2.23±0.10 mmol/L,P=0.040）.However,the levels of serum calcium and serum intact parathyroid hormone kept steady after the 10 weeks＇ observation.The levels of serum FGF23 and α-Kloth decreased after taking lanthanum carbonate in all 12 patients （P＜0.05）,and the level of FGF23 slightly increased after taking calcium carbonate for 4 weeks.Conclusions Lanthanum carbonate can control serum phosphorus,reduce the levels of serum FGF23 in a short term.