烟酰胺在治疗维持性血液透析尿毒症高磷血症患者中的临床应用.docVIP

烟酰胺在治疗维持性血液透析尿毒症高磷血症患者中的临床应用 　　[摘要]目的 观察烟酰胺治疗尿毒症高磷血症的效果。方法 选取2015年1月～2016年1月湘雅萍矿合作医院血透中心收治的20例行维持性血液透析的尿毒症高磷血症患者进行研究，并给予患者口服烟酰胺片治疗，治疗3、6个月后统计数据并评定疗效。结果 治疗3个月后35%的尿毒症患者血磷检测达标，治疗6个月后75%的尿毒症患者血磷检测达标。与治疗前比较，治疗后3个月血磷、钙磷乘积水平下降，差异有统计学意义（P0.05）。与治疗前比较，治疗后6个月钙磷乘积、iPTH水平下降，差异有统计学意义（P0.05）。结论 口服烟酰胺片可有效降低维持型血液透析患者血磷和钙磷乘积，不影响血钙值，未增加血管钙化风险。 　　[关键词]烟酰胺；高磷血症；尿毒症；血液透析 　　[中图分类号] R692.5 [文献标识码] A [文章编号] 1674-4721（2016）10（b）-0057-03 　　[Abstract]Objective To observe the effect of nicotinamide in the treatment of hyperphosphatemia in uremia.Methods 20 uremic patients with high phosphorus in maintenance hemodialysis admitted in Xiangya Ping Mine Cooperative Hospital Hemodialysis Center from January 2015 to January 2016 were studied and given oral nicotinamide tablets treatment，after treatment for 3 and 6 months，the datas were statisticed and effect was evaluated.Results After treatment for 3 months， serum phosphorus detection in 35% of patients with uremia is up to the standard，after treatment for 6 months 75% of whom.Compared with before treatment，serum phosphorus and product of calcium and phosphorus level were decreased after treatment for 3 months，and the difference was statistically significant （P0.05）.Compared with before treatment，product of calcium and phosphorus and iPTH level after treatment for 6 months were decreased，and the difference was statistically significant （P0.05）.Conclusion Oral nicotinamide tablets can effectively reduce serum phosphorus and product of calcium and phosphorus in patients with maintaining hemodialysis，which does not affect calcium value and increase the risk of vascular calcification. 　　[Key words]Nicotinamide；Hyperphosphatemia；Uremia；Hemodialysis 　　高磷血症是终末期肾脏病患者常见的并发症，不仅可以引起继发性甲状旁腺功能亢进、肾性骨病[1]，而且可引起心肌、心脏瓣膜、血管、软组织等转移性钙化[2]，导致维持性尿毒症患者的猝死，与透析患者的病死率及患病率密切相关[3]。给尿毒症患者带来巨大痛苦，长期以来也一直是困扰肾内科医生的难题。目前仅减少磷的摄入及加强透析对血磷清除的方法，难以控制血磷水平，需口服降磷药物治疗。市面上以含钙磷结合剂为多见，通过理化作用形成不可吸收的物质而减少血磷吸收，但易促进高钙血症、转移性钙化的发生。含铝的磷结合剂可致铝中毒及铝性骨病，不宜长期服用。非铝非钙型磷结合剂价格昂贵，目前为非医保内用药，大部分患者难以承担