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目的分析醋酸钙和复方α-酮酸对维持性血液透析(maintenance hemodialysis,MHD)患者钙磷代谢的影响。方法选择2014年5月—2015年5月112例接受治疗的MHD合并高磷血症患者实施研究,根据随机数字法将患者分成醋酸钙组(37例)、复方α-酮酸组(36例)以及联合用药组(39例),3组患者均保持低蛋白饮食,治疗12周后比较3组治疗前后的钙磷代谢指标水平、营养指标水平,以及治疗后的不良反应。结果治疗前3组的血钙、血磷、血钙磷乘积以及甲状旁腺激素水平相比,组间差异无统计学意义(P>0.05);治疗后联合用药组的血磷、血钙磷乘积以及甲状旁腺激素水平均分别低于醋酸钙组和复方α-酮酸组,差异有统计学意义(P<0.05)。治疗前3组的肌酐、血清总蛋白以及白蛋白水平相比,差异无统计学意义(P>0.05);治疗后联合用药组的血清总蛋白及白蛋白水平均分别高于醋酸钙组和复方α-酮酸组,差异有统计学意义(P<0.01)。3组不良反应发生率差异无统计学意义(P>0.05)。结论利用醋酸钙片联合复方α-酮酸对MHD合并高磷血症实施治疗,能够有效改善患者的症状,降低血磷水平,安全性较高,效果优于单项用药,值得推荐。
Objective To analyze the effect of calcium acetate and compound α-keto acid on the metabolism of calcium and phosphorus in patients with maintenance hemodialysis (MHD). METHODS: From May 2014 to May 2015, 112 patients with MHD complicated with hyperphosphatemia undergoing treatment were enrolled. Patients were divided into calcium acetate group (n = 37), compound α-keto acid group (n = 36) ) And combination therapy group (39 cases). The three groups all maintained low-protein diet. After 12 weeks of treatment, the levels of calcium and phosphorus metabolism indices, nutritional indexes and adverse reactions after treatment were compared between the three groups before and after treatment. Results There was no significant difference between the three groups in the levels of serum calcium, phosphorus, calcium and phosphorus before treatment and the level of parathyroid hormone (P> 0.05). After treatment, the levels of serum phosphorus, serum calcium Product and parathyroid hormone levels were lower than the calcium acetate group and compound α-keto acid group, the difference was statistically significant (P <0.05). There were no significant differences in creatinine, serum total protein and albumin levels between the three groups before treatment (P> 0.05). After treatment, the levels of serum total protein and albumin in the combination group were higher than those in the calcium acetate group and the compound prescription group α-ketoacid group, the difference was statistically significant (P <0.01). There was no significant difference in the incidence of adverse reactions between the three groups (P> 0.05). Conclusions The treatment of MHD combined with hyperphosphatemia with calcium acetate tablets and compound α-keto acid can effectively improve the symptoms of patients and reduce the level of serum phosphorus, which is safe and effective. It is worth recommending.