摘要
目的 探讨碳酸司维拉姆联合碳酸镧治疗慢性肾衰竭血液透析患者的临床疗效及对血清炎症因子的影响.方法 前瞻性选取2021年10月至2023年10月在南京市高淳人民医院进行血液透析的慢性肾衰竭患者90例为研究对象.按照随机数字表法将患者分为两组,各45例.所有患者接受血液透析治疗,4 h/次,3次/周.同时接受含降压控糖、调血脂、肾保护,避免摄入高磷食物等常规治疗.碳酸镧组:在以上基础上给予碳酸镧咀嚼片治疗,口服,50 mg/次,3次/d.联合组:在碳酸镧组的基础上给予碳酸司维拉姆片治疗,口服,0.8 g/次,3次/d.两组患者均连续治疗3个月.比较两组患者的临床疗效.比较两组患者治疗前、治疗3个月后的代谢指标[血钙、血磷、钙磷乘积、甲状旁腺激素(PTH)]、炎症因子[C-反应蛋白(CRP)及白细胞介素-6(IL-6)]水平,并记录两组患者治疗期间不良反应发生情况.结果 联合组总有效率为95.56％,明显高于碳酸镧组(77.78％),差异有统计学意义(P＜0.05).治疗3个月后,两组的血钙水平均较治疗前升高,血磷、钙磷乘积、PTH水平均较治疗前降低,且联合组的血钙水平为(2.49±0.35)mmol/L,高于碳酸镧组[(2.31±0.30)mmol/L],血磷、钙磷乘积、PTH 水平分别为(1.09±0.14)mmol/L、2.74±0.42、(310.26±35.03)ng/L,均低于碳酸镧组[(1.37±0.18)mmol/L、3.27±0.49、(441.13±49.68)ng/L],差异均有统计学意义(P＜0.05).治疗3个月后,两组的血清IL-6、CRP水平均较治疗前降低,且联合组的血清IL-6、CRP水平分别为(4.18±0.84)ng/L、(5.12±0.92)mg/L,均低于碳酸镧组[(5.31±1.02)ng/L、(6.50±1.13)mg/L],差异均有统计学意义(P＜0.05).治疗期间,联合组总不良反应发生率为8.89％,与碳酸镧组(11.11％)比较,差异无统计学意义(P＞0.05).结论 对于慢性肾衰竭血液透析患者,在采用碳酸镧的基础上给予碳酸司维拉姆进行联合治疗可协同增效,有效调节血钙、血磷及PTH水平,降低血清炎症因子水平,且安全性良好.
Abstract
Objective To explore the clinical efficacy of sevelamer carbonate combined with lanthanum carbonate in the treatment of he-modialysis patients with chronic renal failure and its effect on serum inflammatory factors.Methods A total of 90 patients with chronic renal fail-ure who underwent hemodialysis in Nanjing Gaochun People's Hospital from October 2021 to October 2023 were prospectively selected as the study subjects.The patients were divided into two groups according to the random number table method,45 cases in each group.All patients received hemodialysis treatment,4 h/time,3 times/week.At the same time,they received routine treatment including antihypertensive and glucose con-trol,blood lipid regulation,renal protection,and avoidance of high phosphorus food.Lanthanum carbonate group:on the basis of the above,lan-thanum carbonate chewable tablets were given orally,50 mg/time,3 times/d.Patients in the combined group were po administered with sevelamer carbonate tablets on the basis of the lanthanum carbonate group,0.8 g/time,three times daily.Patients in two groups were treated for 3 months.The levels of metabolic indexes[blood calcium,blood phosphorus,calcium-phosphorus product,parathyroid hormone(PTH)],inflammatory factors C-reactive protein(CRP)and interleukin-6(IL-6)]before treatment and 3 months after treatment were compared between the two groups,and the occurrence of adverse reactions during treatment was recorded.Results The total effective rate of the combined group was 95.56％,which was significantly higher than that of the lanthanum carbonate group(77.78％),and the difference was statistically significant(P＜0.05).After 3 months of treatment,the serum calcium levels of the two groups were higher than those before treatment,and the serum phosphorus,calcium-phosphorus product,and PTH levels were lower than those before treatment.The serum calcium level of the combined group was(2.49±0.35)mmol/L,which was higher than that of the lanthanum carbonate group[(2.31±0.30)mmol/L],the serum phos-phorus,calcium-phosphorus product,and PTH levels were(1.09±0.14)mmol/L,2.74±0.42,and(310.26±35.03)ng/L,respectively.They were lower than those in lanthanum carbonate group[(1.37±0.18)mmol/L,3.27±0.49,(441.13±49.68)ng/L],and the differ-ences were statistically significant(P＜0.05).After 3 months of treatment,the levels of serum IL-6 and CRP in the two groups were lower than those before treatment,and the levels of serum IL-6 and CRP in the combined group were(4.18±0.84)ng/L and(5.12±0.92)mg/L,re-spectively,which were lower than those in the lanthanum carbonate group[5.31±1.02)ng/L,(6.50±1.13)mg/L],the differences were sta-tistically significant(P＜0.05).During the treatment,the incidence of total adverse reactions in the combined group was 8.89％,which was not significantly different from that in the lanthanum carbonate group(11.11％)(P＞0.05).Conclusion For hemodialysis patients,the combina-tion treatment with sevelamer carbonate on the basis of lanthanum carbonate can synergistically increase efficacy,effectively regulate blood calci-um,phosphorus,and PTH levels,reduce serum inflammatory factor levels,and have good safety.
维普
万方数据