生大黄联合药用活性炭对血液透析高磷血症患者血磷、钙磷乘积及甲状旁腺激素水平的影响
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摘要
目的研究生大黄联合药用活性炭对高磷血症的血液透析患者血磷、钙磷乘积及甲状旁腺激素水平的影响。方法 126例经含钙的磷结合剂治疗后仍存在高磷血症的血液透析患者,按照随机数字表法分为治疗组和对照组,每组63例。治疗组予生大黄(80 mg/kg,每日2次,泡水150 m L,餐前口服)联合药用活性炭(1.5 g/次,每日3次,餐中口服);对照组予药用活性炭治疗(1.5 g/次,每日3次),两组疗程均为8周。检测治疗前和治疗后2、4、6、8周两组患者的血磷、血钙、钙磷乘积和甲状旁腺激素水平;观察患者胃肠道不良反应。结果试验组退出12例,完成51例,对照组退出9例,完成54例。与本组治疗前比较,治疗组治疗后2~8周血磷、钙磷乘积和甲状旁腺激素水平降低(P<0.05),对照组治疗后4~8周降低(P<0.05)。与对照组比较,治疗组治疗后2周患者血磷、钙磷乘积和甲状旁腺激素明显下降(P<0.05)。两组血钙水平比较,差异无统计学意义(P>0.05)。患者主要不良反应为胃肠道反应:包括腹胀、腹泻、肛门坠胀和便秘。与对照组比较,治疗组胃肠道反应中腹胀、便秘和总发生率均降低(χ2=6.815、7.011、7.077,P<0.05)。结论高磷血症透析患者在继续原有磷结合剂治疗基础上,联合使用生大黄和药用活性炭能有效地降低血磷水平、钙磷乘积、甲状旁腺激素水平和胃肠道的并发症。
Objective To study the effect of rhubarb combined medicinal activated carbon on levels of serum phosphorus and calcium-phosphorus product, as well as parathyroid hormone in hemodialysis patients with hyperphosphatemia. Methods Totally 126 hemodialysis patients with hyperphosphatemia who had received treatment of calcium containing phosphorus binders were assigned to the treatment group and the control group according to random digit table, 63 in each group. Patients in the treatment group took rhubarb(80 mg/kg, twice per day, soaked in150 m L boiled water, taken before dinner) combined with medicinal activated carbon(1. 5 g each time, thrice per day,taken during dinner). Those in the control group took medicinal activated carbon(1. 5 g each time, thrice per day,taken during dinner). The therapeutic course for all was 8 weeks. Levels of serum calcium, phosphorus, calcium-phosphorus product and parathyroid hormone were detected in the two groups before treatment, and at week 2, 4, 6, and8 after treatment. Adverse reactions of gastrointestinal tract were observed as well. Results Twelve patients dropped out in the treatment group and the rest 51 completed the study. Nine patients dropped out in the treatment group and the rest 54 completed the study. Compared with before treatment in the same group, levels of serum phosphorus, cal-cium-phosphorus product, parathyroid hormone began to decline from week 2 to 8 in the treatment group(P < 0. 05);and they began to decline from week 4 to 8 in the control group(P < 0. 05). Compared with the control group, levels of serum phosphorus, calcium-phosphorus product, parathyroid hormone obviously decreased in the treatment group(P< 0. 05). But there was no statistical difference in serum calcium level(P > 0. 05) between the two groups. Main adverse reactions of gastrointestinal tract mainly included abdominal distention, diarrhea, anal pedant expansion, and constipation. Compared with the control group, the incidence of abdominal distention and constipation, as well as the total incidence of gastrointestinal reactions all decreased in the treatment group(χ2= 6. 815,7. 011,7. 077, P < 0. 05).Conclusion In addition to previous phosphorus binders therapy, rhubarb combined medicinal activated carbon could effectively reduce levels of serum phosphorus, calcium-phosphorus product, parathyroid hormone in hemodialysis patients with hyperphosphatemia, and lessen complications of gastrointestinal tract.
Objective To study the effect of rhubarb combined medicinal activated carbon on levels of serum phosphorus and calcium-phosphorus product, as well as parathyroid hormone in hemodialysis patients with hyperphosphatemia. Methods Totally 126 hemodialysis patients with hyperphosphatemia who had received treatment of calcium containing phosphorus binders were assigned to the treatment group and the control group according to random digit table, 63 in each group. Patients in the treatment group took rhubarb(80 mg/kg, twice per day, soaked in150 m L boiled water, taken before dinner) combined with medicinal activated carbon(1. 5 g each time, thrice per day,taken during dinner). Those in the control group took medicinal activated carbon(1. 5 g each time, thrice per day,taken during dinner). The therapeutic course for all was 8 weeks. Levels of serum calcium, phosphorus, calcium-phosphorus product and parathyroid hormone were detected in the two groups before treatment, and at week 2, 4, 6, and8 after treatment. Adverse reactions of gastrointestinal tract were observed as well. Results Twelve patients dropped out in the treatment group and the rest 51 completed the study. Nine patients dropped out in the treatment group and the rest 54 completed the study. Compared with before treatment in the same group, levels of serum phosphorus, cal-cium-phosphorus product, parathyroid hormone began to decline from week 2 to 8 in the treatment group(P < 0. 05);and they began to decline from week 4 to 8 in the control group(P < 0. 05). Compared with the control group, levels of serum phosphorus, calcium-phosphorus product, parathyroid hormone obviously decreased in the treatment group(P< 0. 05). But there was no statistical difference in serum calcium level(P > 0. 05) between the two groups. Main adverse reactions of gastrointestinal tract mainly included abdominal distention, diarrhea, anal pedant expansion, and constipation. Compared with the control group, the incidence of abdominal distention and constipation, as well as the total incidence of gastrointestinal reactions all decreased in the treatment group(χ2= 6. 815,7. 011,7. 077, P < 0. 05).Conclusion In addition to previous phosphorus binders therapy, rhubarb combined medicinal activated carbon could effectively reduce levels of serum phosphorus, calcium-phosphorus product, parathyroid hormone in hemodialysis patients with hyperphosphatemia, and lessen complications of gastrointestinal tract.
引文
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[2]侯晓艳.骨化三醇冲击治疗血透患者继发甲旁亢的疗效观察[J].中国中西医结合肾病杂志,2014,15(1):52-54.
[3]Noordzij M,Korevaar JC,Boeschoten EW,et al.The kidney disease outcomes quality initiative(K/DOQI)guideline for bone metabolism and disease in CKD:association with mortality in dialysis patients[J].Am J Kidney Dis,2005,46(5):925-932.
[4]Kopple JD.National kidney foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure[J].Am J Kidney Dis,2001,37(1):S66-S70.
[5]Lessard M,Ouimet D,Leblanc M,et al.Comparison of oral and intravenous alfacalcidol in chronic hemodialysis patients[J].BMC Nephrol,2014,15(1):27.
[6]De Francisco ALM,Ghezzi PM,Brendolan A,et al.Hemodiafiltration with online regeneration of the ultrafiltrate[J].Kidney Int,2000,58:S66-S71.
[7]Bernardo AP,Contesse SA,Bajo MA,et al.Peritoneal membrane phosphate transport status:a cornerstone in phosphate handling in peritoneal dialysis[J].Clin J Am Soc Nephrol,2011,6(3):591-597.
[8]王尊松,许冬梅,崔美玉,等.口服活性炭片降低血液透析患者血磷的疗效观察[J].中国医学工程,2010,3(18):15-16.