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目的:观察低钙透析液配合口服碳酸钙及活性维生素D3对持续性不卧床腹膜透析(CAPD)患者颈动脉粥样硬化的影响。方法:30例伴有颈动脉粥样硬化行CAPD的患者,改用低钙透析液(钙1.25mmol/L),同时调整碳酸钙及1,25-(OH)2维生素D3(罗盖全胶丸)的剂量。在改用低钙透析液3、6、9、12月时,采用多普勒超声观察颈动脉内-中膜厚度(IMT)、颈动脉血流阻力指数(RI)、颈动脉粥样斑块数量和超声分型的变化;同时检测血清钙、磷、血清甲状旁腺素(iPTH,放免法),计算钙磷乘积。结果:随访过程中,1例患者死亡,2例患者自行退出。低钙透析液CAPD后,患者颈动脉IMT逐渐变薄,12个月时降至最低[(1.58±0.36)mm,P<0.01]。伴随着颈动脉RI降低,8例患者颈动脉内的扁平斑及软斑数量减少(P<0.05),颈动脉粥样硬化斑块总数量也由47块降至34块。与此同时,血钙、磷及钙磷乘积明显下降(P<0.01),血iPTH明显增加(P<0.01)。至12月时钙、磷、钙磷乘积、iPTH达标比例分别为83.33%、70%、96.67%、70%。碳酸钙的剂量也由(2.27±0.41)g/d增至(3.35±0.22)g/d(P<0.05),罗盖全剂量由(0.21±0.09)μg/d增至(0.33±0.14)μg/d(P<0.05)。患者均未发生低钙抽搐、低血压等。结论:低钙透析有助于尿毒症腹膜透析患者颈动脉粥样硬化的疾病转归,其机制可能与显著改善患者的钙磷代谢紊乱,减轻其对血管的损伤作用有关。
Objective: To observe the effect of low calcium dialysate combined with oral calcium carbonate and active vitamin D3 on carotid atherosclerosis in patients with continuous ambulatory peritoneal dialysis (CAPD). Methods: Thirty patients with CAPD accompanied by carotid atherosclerosis were treated with low calcium dialysate (1.25mmol / L) and calcium carbonate and 1,25- (OH) 2 vitamin D3 Pill) dose. In low-calcium dialysate switched to 3, 6, 9, 12 months, the use of Doppler ultrasound carotid intima-media thickness (IMT), carotid artery resistance index (RI), carotid atherosclerotic plaque Quantity and type of ultrasound changes; simultaneous detection of serum calcium, phosphorus, serum parathyroid hormone (iPTH, radioimmunoassay), calculation of calcium and phosphorus products. Results: During follow-up, one patient died and two patients quit on their own. After low-calcium dialysate CAPD, carotid IMT gradually thinned to a minimum at 12 months [(1.58 ± 0.36) mm, P <0.01]. With the decrease of carotid artery RI, the number of flat plaque and soft plaque in carotid artery decreased in 8 cases (P <0.05), and the total number of carotid atherosclerosis plaque decreased from 47 to 34. At the same time, the product of serum calcium, phosphorus and calcium decreased significantly (P <0.01), and the blood iPTH increased significantly (P <0.01). By December, calcium, phosphorus, calcium and phosphorus products, iPTH compliance rates were 83.33%, 70%, 96.67%, 70%. The dose of calcium carbonate also increased from (2.27 ± 0.41) g / d to (3.35 ± 0.22) g / d (P <0.05), and the total dose of Capecitabine increased from 0.21 ± 0.09 μg / d to 0.33 ± 0.14 μg / d (P <0.05). Patients did not occur low calcium convulsions, hypotension and so on. CONCLUSION: Low calcium dialysis is helpful for the outcome of carotid atherosclerosis in uremic peritoneal dialysis patients. The mechanism may be related to the significant improvement of disorders of calcium and phosphorus metabolism and the reduction of its damage to blood vessels.