兰莎 张国胜

【摘要】 目的：分析司维拉姆治疗慢性肾衰竭维持性血液透析患者高磷血症的有效性及對炎症因子的影响。方法：选取本院2015年3月-2018年3月收治的慢性肾衰竭的高磷血症患者70例作为研究对象，按照随机数字表法将其分成观察组和对照组，各35例。对照组给予碳酸钙D3片治疗，1片/次，餐中口服，2次/d；观察组给予司维拉姆片治疗，初始剂量1片/次，餐中口服，3次/d，治疗2周后当患者血磷>1.78 mmol/L时，每天给药剂量增加1片，血磷1.13～1.78 mmol/L维持原剂量，血磷<1.13 mmol/L减量或停药。比较两组临床疗效、治疗前后的C反应蛋白（CRP）水平以及不良反应发生情况。

结果：观察组治疗总有效率为94.29%明显高于对照组的77.14%，差异有统计学意义（字2=4.200，P=0.040）。治疗前两组CRP水平比较，差异无统计学意义（P>0.05）；治疗后，两组CRP水平与治疗前比较均明显降低，且观察组明显低于对照组，差异均有统计学意义（P<0.05）。观察组不良反应发生率为11.43%，对照组不良反应发生率为20.00%，两组不良反应发生情况比较，差异无统计学意义（字2=0.971，P=0.325）。结论：司维拉姆治疗慢性肾衰竭维持性血液透析的高磷血症患者能够有效降低患者炎症因子水平，调节血磷水平，治疗效果显著，安全性良好。

【关键词】 司维拉姆； 慢性肾衰竭； 血液透析； 高磷血症； CRP

【Abstract】 Objective：To analyze the effectiveness of Sevelamer on hyperphosphatemia in chronic renal failure patients with maintenance hemodialysis and its influence on inflammatory factors.Method：A total of 70 patients with hyperphosphatemia of chronic renal failure admitted in our hospital from March 2015 to March 2018 were selected as the study objects.According to the random number table method，they were divided into observation group and control group，35 cases in each group.The control group was given Calcium Carbonate D3 Tablets treatment，1 piece/time，oral meal，2 times/d；the observation group was given Sevelamer Tablets treatment，the initial dose 1 piece/time，oral meal，3 times/d，after treatment 2 weeks，when blood phosphorus tendency of patients were more than 1.78 mmol/L，daily dose increased by 1 tablet，the blood phosphorus tendency were 1.13-1.78 mmol/L to maintain the original dose， blood phosphorus tendency were less than 1.13 mmol/L to reduction or withdrawal.The clinical efficacy，the level of C reactive protein （CRP） before and after treatment and the incidence of adverse reactions between the two groups were compared.Result：The effective rate of the observation group was 94.29%，which was significantly higher than 77.14% of the control group，the difference was statistically significant （字2=4.200，P=0.040）.There was no significant difference in the CRP level between the two groups before treatment （P>0.05）；after treatment，the CRP level of the two groups were significantly lower than those before treatment，and the observation group was significantly lower than that in the control group，the differences were statistically significant （P<0.05）.The incidence of adverse reactions was 11.43% in observation group and 20.00% in control group，there was no significant difference in the incidence of adverse reactions between the two groups （字2=0.971，P=0.325）.Conclusion：Sevelamer in the treatment of hyperphosphatemia patients with maintenance hemodialysis of chronic renal failure can effectively reduce the level of inflammatory factors and regulate the level of blood phosphorus，the therapeutic effect is significant and the safety is good.

【Key words】 Sevelamer； Chronic renal failure； Hemodialysis； Hyperphosphatemia； CRP

First-authors address：Gaoan Hospital of Traditional Chinese Medicine，Gaoan 330800，China

doi：10.3969/j.issn.1674-4985.2018.32.038

慢性肾衰竭指的是多因素引发的慢性进行性肾脏疾病，患者临床主要表现为肾单位逐渐硬化，体内水、酸碱度、电解质平衡紊乱，代谢物潴留，长期伴有高血磷症状，病情进展至终末期阶段极易诱发多系统组织衰竭情况，危及患者生命安全[1]。临床研究发现，高磷血症属于慢性肾衰竭病例高发并发症类型之一，在全部慢性肾衰竭病例中达到了80%[2]。目……