曾蕾　苏华燕　黄雷招　杨天开

[摘要] 目的 探讨调控全段甲状旁腺素对糖尿病肾病患者血管钙化及预后的影响。方法 方便选取2013年1月—2016年12月收治的237例糖尿病肾病（IV期及V期）患者并随机分为治疗组（n=129）和对照组（n=108）。对照组接受常规治疗包括饮食控制、胰岛素降血糖治疗及血液净化治疗，治疗组在常规治疗的基础上联合碳酸司维拉姆口服。对比两组治疗前后血磷、钙磷乘积、甲状旁腺素水平，并统计3年后冠状动脉钙化积分、冠状动脉钙化率、心血管事件病死率。结果 治疗前两组血磷、血钙、钙磷乘积、全段甲状旁腺素水平差异无统计学意义（P>0.05），治疗后对照组上述指标水平与治疗前差异无统计学意义（P>0.05）、而治疗组上述指标水平均较治疗前显著降低[（1.8±0.4）mmol/L vs（2.1±0.5）mmol/L；（1.6±0.2）mmol/L vs （1.8±0.2）mmol/L；（3.1±0.6）mmol2/L2 vs（4.3±0.7）mmol2/L2；（244.2±21.5）ng/L vs（383.2±29.3）ng/L]（P<0.05），且治疗后组间差异有统计学意义（P<0.05）；3年后冠状动脉钙化积分、冠状动脉钙化率、心血管事件病死率治疗组均显著低于对照组[（32.1±7.1）分 vs （83.5±22.4）分；8.73% vs 51.04%； 2.33% vs 11.11%]（P<0.05）。结论 糖尿病肾病（IV期及V期）患者采用碳酸司維拉姆口服治疗能够通过下调全段甲状旁腺素水平减轻血管钙化，进而可以显著改善预后。

[关键词] 甲状旁腺素；糖尿病肾病；血管钙化；预后

[中图分类号] R587 [文献标识码] A [文章编号] 1674-0742（2017）07（c）-0021-03

[Abstract] Objective To study the effect of serum intact parathyroid hormone adjustment on the angiosteosis and prognosis of diabetic nephropathy. Methods Convenient selection 237 cases of patients with diabetic nephropathy in the IV stage and V stage in our hospital from January 2013 to December 2016 were selected and divided into two groups， the control group adopted the routine treatment including the dieting control and insulin hypoglycemic therapy and blood purification therapy， and the treatment group took the sevelamer carbonate orally on the basis of the routine treatment， and the phosphorus， calcium and phosphorus products， parathyroid hormone levels of the two groups were compared and the coronary artery calcification score and rate and morality of cardiovascular events after three years were counted. Results Before treatment， there were no obvious differences in the serum phosphorus， calcium， calcium phosphorus product， parathyroid hormone levels before treatment（P>0.05）， after treatment， there were no obvious differences in the above index levels before and after treatment（P>0.05）， and the above index level in the treatment group was obviously decreased[（1.8±0.4）mmol/L vs （2.1±0.5）mmol/L；（1.6±0.2）mmol/L vs（1.8±0.2）mmol/L；（3.1±0.6）mmol2/L2 vs（4.3±0.7）mmol2/L2；（244.2±21.5）ng/L vs （383.2±29.3）ng/L]（P<0.05）， after treatment， the differene was obvious（P<0.05）， and the coronary artery calcification score and rate and morality of cardiovascular events after three years were obviously lower than those in the control group [（32.1±7.1）points vs （83.5±22.4）points；8.73% vs 51.04%； 2.33% vs 11.11%]（P<0.05）. Conclusion The oral administration of sevelamer carbonate in patients with diabetic nephropathy in the IV stage and V stage can relieve the angiosteosis by decreasing the serum intact parathyroid hormone level thus obviously improving the prognosis.endprint

[Key words] Parathyroid hormone； Diabetic nephropathy； Angiosteosis； Prognosis

作为糖尿病患者最为重要的并发症之一，糖尿病肾病的发病率正逐年升高，在各种疾病导致的终末期肾脏病中，该病的构成比位居第2位，仅次于肾小球肾炎[1]。糖尿病肾病不同发病时期的临床表现也存在明显的不同，前期主要表现为肾小球高滤过和肾脏肥大，若病情发展则可出现尿微量蛋白，且随着病情加重出现肾小球滤过率降低、肾功能衰竭等症状，给患者的生存质量造成了严重的影響。碳酸司维拉姆是慢性肾衰竭钙磷代谢异常常用的治疗药物，在慢性肾衰竭钙磷代谢异常治疗中该药物能够改善代谢状态，预防血管钙化[2]。然而糖尿……