摘要:Objective To explore the Efficacy of lanthanum carbonate on hyperphosphatemia in maintenance hemodialysis(MHD)patients.Methods 60 MHD patients were selected from First People's Hospital of Yinchuan from May,2013 to May,2015. The patients were divided into two groups,the calcium carbonate(CC) group and the lanthanum carbonate(LC)group,oral three times a day with diet,dose of 1500 mg and 900 mg a day,respectively. The indicators of body mass index(BMI),blood routine,biochemical indicators,biochemical measures of kidney and liver function,intact parathyroid hormone,serum calcium and phosphate. Fibroblast growth factor-23(FGF23)and endothelin measured were analyzed by ELISA,and compared the levels from baseline and after12 weeks treatment.Results Serum phosphate,LDL and iPTH were decreased(P<0.01),as well as endothelin increased significantly in CC group after 12 weeks therapy(compared with those at baseline, P<0.01). In contrast,the serum phosphate,FGF23,1,25-(OH)2D3 and iPTH decreased significantly in LC group compared with before the treatment(P<0.01). The serum calcium,endothelin and FGF23 in LC group were significantly lower than those in CC group after 12 weeks therapy(P<0.05). There was no statistical significant difference in rest indexes(P>0.05).Conclusion Lanthanum carbonate can decrease serum phosphate,FGF23 but can not increase serum calcium while it can reduce the risk of coronary artery calcification in MHD patients.%目的 分析维持性血液透析患者使用碳酸镧干预高磷血症的效果,为临床更好地应用这一药物提供指导.方法 选择2013年5月-2015年5月银川市第一人民医院血液透析中心维持性血液透析(maintenance hemodialysis,MHD)患者并发高磷血症的共60例,根据治疗方法 分为两组:碳酸镧组和碳酸钙组,药物随餐口服每天3次,剂量分别为每天1500 mg和900mg,,所有患者治疗前和治疗12周之后,测定体重指数(BMI),空腹采血检测血常规、生化全项、肝肾功能、全段甲状旁腺激素(intact parathyroid hormone,iPTH)、血钙和血磷.ELISA法检测成纤维细胞生长因子23(fibroblast growth factor23,FGF23)和内皮素浓度.并进行为期1年的随访,统计患者不良事件发生的比例,评估碳酸镧干预对患者的疗效.结果 与治疗前比较,碳酸钙组患者治疗后血磷、LDL、iPTH均下降(P<0.01),内皮素分泌增高(P<0.01);碳酸镧组患者治疗后血磷、FGF23、1,25-(OH)2D3和iPTH水平下降(P<0.01);两组治疗后与治疗前其余指标比较差异均无统计学意义(P>0.05).与碳酸钙组治疗后比较,碳酸镧组血钙,FGF23和内皮素分泌均降低(P均<0.05),1,25-(OH)2D3水平上升(P<0.05),其余指标差异均无统计学意义(P>0.05).结论 碳酸镧可有效降低终末期肾病患者的血磷和FGF23水平,控制患者血钙维持正常水平,对降低MHD患者冠状动脉钙化的风险有一定作用.