标题：低钙腹膜透析液对慢性肾衰竭患者血清钙磷代谢、肾损伤及残余肾功能的影响

      作者：曹丽，曹雷，常露元    榆林市第二医院肾病内科，陕西 榆林 719000

      卷次： 2021年32卷15期

      【摘要】 目的 探讨低钙腹膜透析液对慢性肾衰竭(CRF)患者血清钙磷代谢、肾损伤及残余肾功能的影响。方法 回顾性分析2015年1月至2019年1月在榆林市第二医院肾病内科行腹膜透析的326例CRF患者的临床资料，根据腹膜透析液钙浓度不同分组，其中151例采用低钙透析液者纳入观察组，175例采用标准钙透析液者纳入对照组，经倾向性匹配评分，最终纳入观察组和对照组各74例。规律透析1年后比较两组患者的钙磷代谢[血钙、血磷、全段甲状旁腺激素(iPTH)水平及达标率]和肾损伤指标[尿肾损伤分子(Kim-1)、尿白介素-18 (IL-18)]，同时比较两组患者透析后 6个月、1年残余肾功能(RRF)和 1年内并发症发生情况及 1年生存率。结果 规律腹膜透析1年后观察组患者的血钙、血磷水平明显低于对照组，血钙和血磷达标率分别为78.38%、64.86%，明显高于对照组的58.11%、48.65%，差异均有统计学意义(P<0.05)，但两组患者的 iPTH水平及达标率比较差异均无统计学意义(P>0.05)；规律腹膜透析1年后两组患者的尿Kim-1、IL-18水平明显低于治疗前，且观察组患者的尿Kim-1和 IL-1水平分别为(0.30±0.10) μg/L、(128.64±27.34) ng/L，明显低于对照组的(0.41±0.14) μg/L、(151.25±35.42) ng/L，差异均有统计学意义(P<0.05)；观察组患者治疗6个月和1年后的RRF下降幅度分别(0.36±0.12) mL/min、(1.01±0.26) mL/min，明显低于对照组的(0.75±0.21) mL/min、(1.69±0.31) mL/min，差异均有统计学意义(P<0.05)；1年期间内，观察组患者的心脑血管病并发症发生率为12.16%，明显低于对照组的25.68%，差异有统计学意义(P<0.05)，但两组患者的1年生存率比较差异无统计学意义(P>0.05)。结论 相比标准钙腹膜透析液，低钙透析液更利于CRF患者钙磷代谢调节，对减轻患者肾损伤、延缓残余肾功能下降及降低心脑血管病并发症有积极意义。
      【关键词】 慢性肾衰竭；腹膜透析；低钙透析液；钙磷代谢；肾损伤；残余肾功能
      【中图分类号】 R692.5 【文献标识码】 A 【文章编号】 1003—6350（2021）15—1946—04

Effects of low calcium peritoneal dialysate on serum calcium-phosphorus metabolism, renal injury, and residualrenal function in patients with chronic renal failure.
CAO Li, CAO Lei, CHANG Lu-yuan. Department of Nephrology,Yulin No.2 Hospital, Yulin 719000, Shannxi, CHINA
【Abstract】 Objective To explore the effects of low calcium peritoneal dialysate on serum calcium-phosphorusmetabolism, renal injury, and residual renal function in patients with chronic renal failure (CRF). Methods The clinicaldata of 326 patients with CRF undergoing peritoneal dialysis in Department of Nephrology, Yulin No.2 Hospital betweenJanuary 2015 and January 2019 were retrospectively analyzed. The patients were grouped according to the different calci-um concentrations of peritoneal dialysate. A total of 151 patients with low calcium dialysate were included in the obser-vation group and 175 patients undergoing standard calcium dialysate were selected as control group. According to thepropensity matching score, 74 cases were finally included in both the observation group and the control group. The calci-um-phosphorus metabolism (levels and compliance rates of blood calcium, blood phosphorus and intact parathyroid hor-mone [iPTH]) and renal injury indicators (urinary kidney injury molecule [Kim-1], urine interleukin-18 [IL-18]) werecompared between the two groups of patients after 1 year of regular dialysis. The residual renal function (RRF) at 6months and 1 year after dialysis and occurrence of complications within 1 year and 1-year survival rate were comparedbetween the two groups. Results After 1 year of regular peritoneal dialysis, the blood calcium and blood phosphorus ofpatients in the observation group were significantly lower than those in the control group, and the compliance rates ofblood calcium and blood phosphorus were 78.38%, 64.86%, significantly higher than 58.11%, 48.65% in the controlgroup (P<0.05). There were no statistically significant differences in the level and compliance rate of iPTH between thetwo groups (P>0.05). After 1 year of regular peritoneal dialysis, the levels of urine Kim-1 and IL-18 in the two groupsof patients were significantly lower than those before treatment, and the levels of urine Kim-1 and IL-18 of patients inobservation group were (0.30±0.10) μg/L, (128.64±27.34) ng/L, significantly lower than (0.41±0.14) μg/L, (151.25±35.42) ng/L in the control group (P<0.05). The RRF decline ranges at 6 months and 1 year after treatment in the observa-tion group were (0.36±0.12) mL/min and (1.01±0.26) mL/min, significantly lower than (0.75±0.21) mL/min and (1.69±0.31) mL/min in the control group (P<0.05). During 1 year, the incidence rate of cardio-cerebrovascular disease in the