低钙透析联合小剂量骨化三醇在血透患者中的应用

目的：探讨维持性血透患者在骨化三醇小剂量治疗继发性甲状旁腺功能亢进同时应用低钙透析液进行透析的安全性和有效性。方法：选择维持性血透患者共59例,合并继发性甲状旁腺功能亢进,用小剂量骨化三醇（罗盖全）口服治疗,每次0.25-0.5μg,1/d,于每晚睡前服用;碳酸钙（钙尔奇）每次1500mg,1/d,午饭时服用。透析采用稀释后浓度为1.25mmol/L的碳酸低钙透析液,观察透析前后血钙、血磷、钙磷乘积和PTH。结果：3个月后血钙维持正常水平,无显著性差异,血磷明显下降,有显著性差异（P〈0.01）,钙磷乘积明显下降,有显著性差异（P〈0.01）,PTH明显下降,有显著性差异（P〈0.01）。结论：维持性血透合并继发性甲状旁腺功能亢进的患者,在口服小剂量骨化三醇（罗盖全）治疗过程中,应用低钙透析液进行透析,可以有效避免高钙血症及转移性钙化的出现,同时有效降低血磷、钙磷乘积,血清甲状旁腺激素水平。

Application of low calcium dialysate and low dose calcitriol for the treatment of secondary hyperparathyroidism in maintenance hemodialysis patients

Objective：To investigate the safety and efficacy of low dose calcitriol and calcium dialysate for the treatment of secondary hyperparathyroidism in maintenance hemodialysis patients. Methods： Fifty-nine maintenance hemodialysis patients with secondary hyperparathyroidism were treated with low dose calcitriol （0.25 to 0.5 μg/d） and calcium carbonate （1 500 mg/d）. Low-calcium dialysate was used in all patients during hemodialysis. The blood calcium, calcium-phosphorus product, serum parathyroid hormone （PTH） and adverse reaction were observed. Results： After the treatment for 3 months,there was no singnificant difference in blood calcium （P〉0.05）, but blood phosphorus, calcium-phosphorus product and serum PTH levels decreased obviously （P〈0.01）. Conclusion： Application of low calcium dialysate and low dose calcitriol for the treatment of secondary hyperparathyroidism in maintenance hemodialysis patients can effectively avoid hypercalcinemia and metastatic calcification, and decrease the blood phosphorus, calcium-phosphorus product and serum PTH levels.