李红梅 曹楠 郭东花

【摘要】 目的：觀察碳酸司维拉姆联合小剂量碳酸钙治疗尿毒症高磷血症患者的临床疗效。方法：选取在本院进行血液透析治疗的尿毒症高磷血症患者46例，随机分成观察组（碳酸司维拉姆+碳酸钙）及对照组（碳酸钙），每组各23例。监测血清钙磷值，每两周一次，根据测定结果进行药物剂量的增减，治疗3、6个月后，分别记录两组治疗前后的血钙、血磷值，钙磷乘积以及全段甲状旁腺激素（iPTH）的变化情况。结果：两组治疗后，患者的血磷以及钙磷乘积均较治疗前降低，观察组较对照组降低明显，差异有统计学意义（P<0.01）;血钙升高，对照组高于观察组，两组比较差异有统计学意义（P<0.05）;iPTH治疗后虽有下降，但差异无统计学意义（P>0.05）。结论：碳酸司维拉姆联合小剂量碳酸钙治疗尿毒症高磷血症优于单纯应用碳酸钙治疗，可有效地降低血磷及钙磷乘积，减少组织钙化，避免高钙血症，提高患者生存质量。

【关键词】 碳酸司维拉姆; 碳酸钙; 尿毒症; 高磷血症

【Abstract】 Objective：To observe the clinical efficacy of combination of sevelamer carbonate and small dose Calcium Carbonate in the treatment of uremic hyperphosphatism.Method：46 patients with uremic hyperphosphatism treated by hemodialysis in our hospital were randomly divided into observation group （Sevelamer Carbonate + Calcium Carbonate）and control group（Calcium Carbonate）.Serum Calcium and Phosphorus levels were monitored every two weeks.Drug doses were increased or decreased according to the results of the test.After treatment 3 months and 6 months，the changes of blood Calcium，Phosphorus，Calcium-Phosphorus product and whole parathyroid hormone（iPTH）were recorded.Result：After treatment，the blood Phosphorus and Calcium-Phosphorus product of the two groups were lower than those before treatment，the observation group was significantly lower than that of the control group.The difference was statistically significant（P<0.01）;the blood Calcium level in the control group was higher than that in the observation group（P<0.05）;there was no significant difference after the treatment of iPTH（P>0.05）.Conclusion：The treatment of uremic hyperphosphatism with Sevelamer carbonate combined with low-dose Calcium carbonate is better than that with Calcium carbonate alone.It can effectively reduce blood phosphorus and Calcium Phosphorus product，reduce tissue calcification，avoid hypercalcemia and improve the quality of life of patients.

【Key words】 Sevelamer Carbonate; Calcium Carbonate; Uremia; Hyperphosphatism

First-authors address：Beijing Central Hospital of Prison Administration Hemodialysis Room，Beijing 100054，China

doi：10.3969/j.issn.1674-4985.2019.16.026

随着血液净化技术的发展，依靠维持性血液透析治疗的尿毒症患者越来越多，生存时间逐渐延长，但是与透析相关的远期并发症出现率也越来越大，其中高磷血症就是众多并发症中最常见的一种。在终末期肾病患者中，高磷血症不仅会促发继发性甲状旁腺机能亢进，从而影响患者的生存期，同时对患者的血管钙化进程产生重要影响[1]。所以，对尿毒症患者来说，高磷血症的治疗就显尤为重要。高磷血症是使患者生活质量降低的独立危险因素，其与慢性肾衰竭的死亡密切相关[2]。治疗高磷血症，除了限制饮食中磷酸盐的摄入及充分透析外，磷结合剂的使用也是重要一环。……