本文選題：碳酸鑭 + 血液透析��； 參考：《青島大學》2015年博士論文

【摘要】：[目的]比較碳酸鑭和碳酸鈣對維持性血液透析高磷血癥患者血磷、成纖維細胞生長因子23(fibroblast growth factor-23,FGF23)和血管內皮功能的影響。[方法]選取50例維持性血液透析高磷血癥患者,按1:1比例分為兩組,經過2周的藥物洗脫期后,分別口服碳酸鈣和碳酸鑭共8周,同時配以低磷飲食,檢測治療前和治療后的血常規(guī)、血糖、血漿白蛋白、25羥維生素D、血鈣、血磷、血甲狀旁腺激素(i PTH),同時檢測FGF23及測定內皮細胞依賴性舒張功能(flow-mediated dilation,FMD)。[結果]治療前,FMD與血磷水平呈負相關(γ=-0.55,P=0.002),同時與FGF23水平呈負相關(γ=-0.56,P0.001)。治療后,碳酸鑭組較碳酸鈣組血磷下降更顯著。碳酸鈣組血鈣升高,碳酸鑭組血鈣下降,二者有顯著差異。碳酸鑭組FGF23較治療前顯著下降,碳酸鈣組FGF23沒有變化。碳酸鑭組FMD顯著升高,從6.1%到7.3%(P0.05),碳酸鈣組沒有變化,仍舊是6.1%。治療后,FMD的變化與FGF23的變化(γ=-0.42,P0.001)、磷的變化(γ=-0.38,P=0.001)均呈負相關。多重線性回歸分析顯示,FGF23的變化是FMD變化的獨立影響因素(β=-0.28,P0.001),而磷的變化不是FMD變化的影響因素(β=0.05,P=0.6)。[結論]碳酸鑭比碳酸鈣不僅降磷效果更顯著,而且可以明顯降低血FGF23水平和改善血管內皮功能,還可以輕度升高25羥維生素D,且不引起血鈣的變化。FGF23所引起的內皮功能不良可能是動脈粥樣硬化的過程中的一個階段。該研究也從臨床角度探索了血磷和血FGF23水平在慢性腎臟病患者動脈硬化過程中所起到的作用,有助于進一步揭開動脈硬化的機制,做好預防和治療。
[Abstract]:[objective] to compare the effects of lanthanum carbonate and calcium carbonate on serum phosphorus, fibroblast growth factor (23(fibroblast growth factor-23) and vascular endothelial function in maintenance hemodialysis patients with hyperphosphatemia. [methods] Fifty patients with maintenance hemodialysis hyperphosphatemia were divided into two groups according to 1:1 ratio. After two weeks of drug elution, calcium carbonate and lanthanum carbonate were taken orally for 8 weeks respectively. Blood routine, blood glucose, plasma albumin 25 hydroxyvitamin D, serum calcium, serum phosphorus, serum parathyroid hormone (PTH) were measured before and after treatment. Meanwhile, FGF23 and endothelium-dependent dilatation function were measured. [results] before treatment, there was a negative correlation between FMD and serum phosphorus level (緯 -0.55P0. 002G), and a negative correlation between FMD and FGF23 level (緯 -0.56U P0.001). After treatment, serum phosphorus in lanthanum carbonate group was significantly lower than that in calcium carbonate group. The serum calcium in calcium carbonate group was higher than that in lanthanum carbonate group, and there was a significant difference between the two groups. The FGF23 in lanthanum carbonate group was significantly lower than that before treatment, but FGF23 in calcium carbonate group was not changed. The FMD of lanthanum carbonate group increased significantly from 6.1% to 7.3% P0.05%, but the calcium carbonate group remained unchanged and remained 6.1%. There was a negative correlation between the changes of FGF23 (緯 -0.42 P 0.001, P 0.001) and phosphorus (緯 -0.38% P0. 001) after treatment. Multiple linear regression analysis showed that the change of FGF23 was an independent factor for the change of FMD (尾 -0.28, P 0.001), but the change of phosphorus was not the influence factor of the change of FMD (尾 -0.05, P0. 6). [conclusion] Lanthanum carbonate is more effective than calcium carbonate in reducing phosphorus, reducing FGF23 level and improving vascular endothelial function. There was also a slight increase in 25 hydroxyvitamin D and no change in serum calcium. Endothelial dysfunction caused by FGF23 may be a stage of atherosclerosis. This study also explores the role of blood phosphorus and FGF23 levels in the process of arteriosclerosis in patients with chronic kidney disease from a clinical point of view, which is helpful to further uncover the mechanism of arteriosclerosis and to do a good job in prevention and treatment.
【學位授予單位】：青島大學
【學位級別】：博士
【學位授予年份】：2015
【分類號】：R692.5

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