磷结合剂对于血液透析高磷血症患者成纤维细胞生长因子-23水平的影响

发布时间：2018-05-30 17:30

本文选题：FGF-23 + 高磷血症　；参考：《厦门大学》2014年硕士论文

【摘要】：目的：近年来,许多研究显示高水平的FGF-23与肾脏疾病进展、心血管病死率及左心室肥厚相关。饮食磷限制及磷结合剂可用来控制磷酸盐平衡及升高的血清FGF-23水平。本研究的目的在于比较碳酸镧和碳酸钙对于维持性血液透析高磷血症患者血清FGF-23水平的影响。方法：选取56例在我科行维持性血液透析治疗的慢性肾功能衰竭患者,所有患者维持性血液透析治疗超过3个月,接受血液透析治疗3次／周,每次4h,碳酸氢盐透析液钙离子浓度为2.5mEq/L。研究期间,患者的血液透析治疗方案保持不变。入选患者符合血磷1.77mmol/L,血钙2.38mmol/L,25-OH-VitD水平30ng/ml,血清白蛋白水平30g/L。患者限制饮食磷摄入量为1000mg/day左右,将患者随机分为两组,分别接受碳酸镧或碳酸钙治疗16周。每2周常规检测血钙、血磷水平,滴定磷结合剂的使用剂量,使血磷水平达标。在治疗的第0、4、16周检测血清FGF-23及iPTH水平。结果：56名患者共有50人完成了本研究,其中碳酸镧组有4人由于出现胃肠道症状暂停碳酸镧治疗,碳酸钙组有2人未按规律服用药物退出本研究。经磷结合剂治疗16周后,两组的血清磷水平比治疗前显著降低(P0.05)。两组中血清校正钙水平的变化无统计学意义,两组的钙-磷乘积水平均有明显降低(P0.05),两组的iPTH水平的变化无统计学意义。在磷结合剂治疗前,碳酸镧组和碳酸钙组FGF-23的基线水平无统计学差异。经碳酸镧治疗后,患者的血清FGF-23水平显著下降；而碳酸钙组FGF-23水平无显著变化。在碳酸镧组,血清磷水平的改变与血清FGF-23水平的改变呈正相关。随着血清磷水平减少越来越大,血清FGF-23水平的减少也越来越显著。结论：总之,在血液透析患者中应用碳酸镧可以有效降低血磷及血清FGF-23水平,而应用碳酸钙并不能减少血清FGF-23水平。因此,使用碳酸镧可以有效治疗高磷血症,也可能通过减少循环FGF-23水平促进CKD患者的存活率。
[Abstract]:Objective: in recent years, many studies have shown that high levels of FGF-23 are associated with renal disease progression, cardiovascular mortality and left ventricular hypertrophy. Dietary phosphorus restriction and phosphate binding agents can be used to control phosphate balance and elevated serum FGF-23 levels. The aim of this study was to compare the effects of lanthanum carbonate and calcium carbonate on serum FGF-23 levels in patients with maintenance hemodialysis hyperphosphatemia. Methods: 56 patients with chronic renal failure who were treated with maintenance hemodialysis in our department were selected. All patients were treated with maintenance hemodialysis for more than 3 months and received hemodialysis three times a week. The calcium ion concentration of bicarbonate dialysate solution was 2.5mEq / L at 4 h each time. The patient's hemodialysis regimen remained unchanged during the study period. Patients were selected according to plasma phosphorus 1.77 mmol / L, serum calcium 2.38 mmol / L, serum calcium 25-OH-VitD level 30 ng / ml, serum albumin level 30 g / L. The patients were divided into two groups randomly and treated with lanthanum carbonate or calcium carbonate for 16 weeks. The levels of serum calcium and phosphorus were routinely measured every 2 weeks, and the dosage of titration phosphorus binder was used to make the blood phosphorus level up to standard. The serum levels of FGF-23 and iPTH were measured at week 0 ~ (th) and week 4 ~ (th) after treatment. Results 50 patients from 56 patients completed the study. Four patients in lanthanum carbonate group suspended lanthanum carbonate treatment because of gastrointestinal symptoms, and two patients in calcium carbonate group did not take drugs regularly to withdraw from the study. After 16 weeks of treatment with phosphorus binder, the serum phosphorus level in both groups was significantly lower than that before treatment. There was no significant difference in serum corrected calcium level between the two groups. The calcium-phosphorus product level in both groups was significantly lower than that in the control group (P 0.05). There was no significant difference in iPTH level between the two groups. There was no significant difference in baseline level of FGF-23 between lanthanum carbonate group and calcium carbonate group before treatment with phosphorus binder. After treatment with lanthanum carbonate, the serum FGF-23 level decreased significantly, but the FGF-23 level of calcium carbonate group did not change significantly. In lanthanum carbonate group, the change of serum phosphorus level was positively correlated with the change of serum FGF-23 level. With the decrease of serum phosphorus level, the decrease of serum FGF-23 level is more and more significant. Conclusion: application of lanthanum carbonate in hemodialysis patients can effectively reduce the level of serum phosphorus and serum FGF-23, but calcium carbonate can not reduce the level of serum FGF-23. Therefore, the use of lanthanum carbonate can effectively treat hyperphosphatemia and may promote the survival rate of patients with CKD by reducing circulating FGF-23 levels.
【学位授予单位】：厦门大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692

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