司维拉姆对慢性肾脏病血管钙化及死亡率的影响.DOC

司维拉姆对慢性肾脏病血管钙化及病死率的影响 刘炎 秦岭 彭艾 摘要：尽管透析技术有了很大进展, 而终末期肾病（ESRD）患者血磷的控制仍面临很大挑战。为了控制血磷水平，不恰当的饮食控制可能会导致更高的病死率，因此合理应用磷结合剂非常必要。传统的磷结合剂由于其副作用逐渐被淘汰。作为非含钙非含铝磷结合剂的代表药物，司维拉姆能在降磷的同时降低血低密度脂蛋白（LDL）水平及高钙血症的风险。此外，司维拉姆对冠状动脉钙化积分（CAC）的进展可能也有保护作用，可以降低慢性肾脏病（CKD）患者心血管事件发生率。对65岁以上的血液透析患者，司维拉姆或许会显著降低全因病死率。磷结合剂的选用应确立个体化治疗方案，对于患有严重血管及其他软组织钙化、高钙血症、高脂血症的CKD患者，应优先选择司维拉姆来降低血磷水平。 关键词：高磷血症;磷结合剂;司维拉姆;血管钙化;病死率 同济大学附属上海第十人民医院肾脏风湿科 Effect of sevelamer on cardiovascular calcification and mortality in patients with chronic kidney disease Liu Yan Qin Ling Peng Ai.Division of Nephrology and Rheumatology，Shanghai Tenth People’s Hospital of Tongji University，Shanghai 200072, China Corresponding auther:Qin Ling,E-mail:coffee1170330@126.com Abstract:Better modalities of dialysis have been improved in the management of end-stage renal disease (ESRD)，however phosphate control is still a major challenge in this group of patients.Dietary phosphorus restriction may finally lead to greater mortality.Therefore,phosphate control generally needs several kinds of phosphate binders.Traditional phosphate binders is being weeded out for their defects. Compared with calcium-containing phosphate binder, as the representative drug of non-calcium and non-aluminum-containing phosphate binders, sevelamer was showed to be effective in lowering serum phosphate and serum LDL，and hypercalcemia was also shown as benefcial co-effect.In addition, sevelamer maybe protective for the progression of coronary artery calcification（CAC）, reducing the incidence of cardiovascular disease event in chronic kidney disease（CKD）patients.In patients 65 years of age there may exist a signifcant effect of sevelamer in lowering the all-cause mortality rate.Individual program should be considered in using phosphate binders.Non-calcium phosphate binders is a prior in CKD patients with severe vascular and/or other soft-tissue calcifcations and in those with hypercalcemia or hyperlipemia. Keywords:hyperphosphataemia；phosphatebinders；sevelamer；car