本文選題：FGF-23 + 高磷血癥��； 參考：《廈門大學(xué)》2014年碩士論文

【摘要】：目的：近年來,許多研究顯示高水平的FGF-23與腎臟疾病進(jìn)展、心血管病死率及左心室肥厚相關(guān)。飲食磷限制及磷結(jié)合劑可用來控制磷酸鹽平衡及升高的血清FGF-23水平。本研究的目的在于比較碳酸鑭和碳酸鈣對(duì)于維持性血液透析高磷血癥患者血清FGF-23水平的影響。 方法：選取56例在我科行維持性血液透析治療的慢性腎功能衰竭患者,所有患者維持性血液透析治療超過3個(gè)月,接受血液透析治療3次／周,每次4h,碳酸氫鹽透析液鈣離子濃度為2.5mEq/L。研究期間,患者的血液透析治療方案保持不變。入選患者符合血磷1.77mmol/L,血鈣2.38mmol/L,25-OH-VitD水平30ng/ml,血清白蛋白水平30g/L�；颊呦拗骑嬍沉讛z入量為1000mg/day左右,將患者隨機(jī)分為兩組,分別接受碳酸鑭或碳酸鈣治療16周。每2周常規(guī)檢測血鈣、血磷水平,滴定磷結(jié)合劑的使用劑量,使血磷水平達(dá)標(biāo)。在治療的第0、4、16周檢測血清FGF-23及iPTH水平。 結(jié)果：56名患者共有50人完成了本研究,其中碳酸鑭組有4人由于出現(xiàn)胃腸道癥狀暫停碳酸鑭治療,碳酸鈣組有2人未按規(guī)律服用藥物退出本研究。經(jīng)磷結(jié)合劑治療16周后,兩組的血清磷水平比治療前顯著降低(P0.05)。兩組中血清校正鈣水平的變化無統(tǒng)計(jì)學(xué)意義,兩組的鈣-磷乘積水平均有明顯降低(P0.05),兩組的iPTH水平的變化無統(tǒng)計(jì)學(xué)意義。在磷結(jié)合劑治療前,碳酸鑭組和碳酸鈣組FGF-23的基線水平無統(tǒng)計(jì)學(xué)差異。經(jīng)碳酸鑭治療后,患者的血清FGF-23水平顯著下降；而碳酸鈣組FGF-23水平無顯著變化。在碳酸鑭組,血清磷水平的改變與血清FGF-23水平的改變呈正相關(guān)。隨著血清磷水平減少越來越大,血清FGF-23水平的減少也越來越顯著。 結(jié)論：總之,在血液透析患者中應(yīng)用碳酸鑭可以有效降低血磷及血清FGF-23水平,而應(yīng)用碳酸鈣并不能減少血清FGF-23水平。因此,使用碳酸鑭可以有效治療高磷血癥,也可能通過減少循環(huán)FGF-23水平促進(jìn)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.
【學(xué)位授予單位】：廈門大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R692

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 姚勇;;慢性腎臟病病因與流行病學(xué)[J];中國實(shí)用兒科雜志;2011年06期

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本文編號(hào)：1956179