醋酸钙联合低钙透析液在老年高钙高磷腹膜透析患者中的应用

目的 探讨醋酸钙联合低钙透析液治疗对并发高钙和高磷血症老年腹膜透析患者钙磷代谢状况的影响.方法 选择行CAPD治疗6m以上、病情稳定且伴有高钙、高磷血症的老年患者20例,随机分为对照组（使用含钙1.5 mmol/L透析液＋饮食控制）和治疗组（使用含钙1.25 mmol/L透析液＋醋酸钙＋饮食控制）,每组10例,分别观察治疗前、治疗后1、3和6个月的血钙、血磷、钙磷乘积、iPTH和相关不良反应.结果 ①共18人完成该临床研究,其中对照组有1人因出现腹透相关性腹膜炎退出研究;试验组有1人因无法耐受服用醋酸钙后出现的恶心、反酸症状而退出试验.②醋酸钙联合低钙透析液治疗组在治疗后第3个月时血钙、血磷及钙磷乘积水平明显降低,血iPTH浓度明显升高,与对照组相比均有统计学差异（P＜0.05）;至第6个月时血钙、血磷及钙磷乘积水平趋于稳定.③两组患者在研究期间除治疗组1人出现肌肉痉挛外,其余患者未见明显不良反应.结论 醋酸钙联合低钙透析液对于合并高钙血症和高磷血症的老年腹膜透析患者具有较好的治疗效果.

Combined therapy with calcium acetate and low calcium dialysate in elderly CAPD patients with hypercalcemia and hyperphosphatemia

Objective To observe effects of calcium acetate in combination with low calcium dialysate on calcium and phosphate metabolism in elderly hypercalcemia and hyperphosphatemia CAPD patients. Methods Twenty elderly hyper- calcemia and hyperphosphatemia CAPD patients who were in stable condition over 6 months were selected and randomly as- signed into control group （ calcium 1.5mmol/L of dialysate＋ diet control） or treatment group （calcium acetate in combination with calcium 1.25 mmol/L of dialysate＋ diet control） （10 cases in each group）. The changes of serum calcium, phosphorus, calcium and phosphorus product, iPTH and related adverse reactions were observed before the study and after 1, 3 and 6 months of the study. Results （1） Eighteen patients completed the clinical study, one patient dropped out of the study because of peritoneal dialysis related peritonitis in control group and one patient withdrew the study because of not being able to bear nausea and acid reflux symptoms after taking calcium acetate in treatment group. （2） After treatment with calcium acetate in combination with low calcium dialysate for 3 months, the serum level of calcium, phosphorus and the calcium-phosphorus product in treatment group was significantly reduced and serum iPTH concentration was increased sig- nificantly compared with control group （P〈0.05）. The level of calcium, phosphorus and the calcium-phosphorus product tended to be stable in 6 months. （3） During the study period, one patient in treatment group had muscle spasm, but the rest of two group patients had no obvious adverse effects. Conclusion Calcium acetate in combination with low calcium dialysate for the treatment of calcium phosphate metabolic disorders in elderly hypercalcemia and hyperphosphatemia CAPD patients is safe and effective and this treatment regiment can also improve patients＇ quality of life.