目的 探讨碳酸镧联合左卡尼汀治疗维持性血液透析慢性肾功能衰竭的临床疗效。方法 选取2019年1月—2021年12月在沧州市中心医院进行治疗的88例维持性血液透析慢性肾功能衰竭患者为研究对象，根据住院号的奇偶分为对照组和治疗组，每组各44例。对照组静脉滴注左卡尼汀注射液，50 mg/kg同0.9%氯化钠注射液100 mL配伍，1次/d；治疗组在对照组治疗基础上口服碳酸镧咀嚼片，0.5 g/次，3次/d。两组均连续治疗3个月。观察两组的临床疗效，比较两组治疗前后相关量表评分、肾功能指标、骨代谢指标、细胞因子指标和血管钙化积分的变化情况。结果 治疗后，治疗组总有效率是93.18%，显著高于对照组的81.82%（P＜0.05）。治疗后，两组生活质量综合评定问卷（GQOLI-74）评分、社会支持评定量表（SSRS）评分、慢性病患者生命质量测定量表体系（QLICD-CRF 2.0）评分均较治疗前显著升高，但急性生理与慢性健康（APACHEⅡ）评分、SAPSⅡ评分均显著降低（P＜0.05），并以治疗组改善的更明显（P＜0.05）。治疗后，两组患者血肌酐（Scr）、尿素氮（BUN）水平均较治疗前显著降低，但内生肌酐清除率（Ccr）水平均显著升高（P＜0.05）；治疗后，治疗组肾功能指标改善优于对照组（P＜0.05）。治疗后，两组血钙（Ca）血磷（P）、全段甲状旁腺激素（iPTH）水平均较治疗前显著降低（P＜0.05），并以治疗组改善更明显（P＜0.05）。治疗后，两组血清基质金属蛋白酶-9（MMP-9）、胱抑素C（CysC）、基质细胞衍生因子-1（TSP-1）、β2-微球蛋白（β2-MG）、人成纤维细胞生长因子-23（FGF-23）均较同组治疗前显著降低，而骨形态发生蛋白-7（BMP-7）显著升高（P＜0.05），并以治疗组改善更明显（P＜0.05）。治疗后，两组患者冠状动脉钙化（CACS）积分、腹主动脉钙化（AACS）积分均显著降低（P＜0.05），并以治疗组改善更明显（P＜0.05）。结论 碳酸镧联合左卡尼汀治疗维持性血液透析慢性肾功能衰竭疗效明显，可有效改善患者肾功能和骨代谢指标，改善血清细胞因子水平，延缓血管钙化，有着良好的临床应用价值。

Objective To investigate the clinical efficacy of lanthanum carbonate combined with levocarnitine in treatment of chronic renal failure on maintenance hemodialysis. Methods A total of 88 patients with chronic renal failure on maintenance hemodialysis who were treated in Cangzhou Central Hospital from January 2019 to December 2021 were selected as the research objects, and were divided into control group and treatment group according to the oddities of hospitalization number, with 44 cases in each group. Patients in the control group were iv administered with Levocarnitine Injection, 50 mg/kg compatible with 0.9% sodium chloride injection 100 mL, once daily. Patients in the treatment group were po administered with Lanthanum Carbonate Chewable Tablets on the basis of the control group, 0.5 g/time, 3 times daily. Both groups were treated for 3 months. The clinical efficacy of the two groups were observed, and the changes of related scales scores, renal function indexes, bone metabolism indexes, cytokine indexes and vascular calcification scores were compared between the two groups before and after treatment. Results After treatment, the total effective rate in the treatment group was 93.18%, significantly higher than that in the control group (81.82%, P < 0.05). After treatment, scores of comprehensive Assessment questionnaire (GQOLI-74), Social Support Rating Scale (SSRS) and QLICD-CRF 2.0 (QLICD-CRF 2.0) in two groups were significantly increased compared with before treatment, but APACHEⅡ score and SAPSⅡ score were significantly decreased (P < 0.05). The improvement was more obvious in the treatment group (P < 0.05). After treatment, the levels of serum creatinine (Scr) and urea nitrogen (BUN) in two groups were significantly decreased compared with before treatment, but endogenous creatinine clearance (CCR) level was significantly increased (P < 0.05). After treatment, the renal function index of the treatment group improved better than that of the control group (P < 0.05). After treatment, the levels of blood calcium (Ca), blood phosphorus (P), and whole parathyroid hormone (iPTH) in two groups were significantly decreased compared with those before treatment (P < 0.05), and the improvement was more obvious in the treatment group (P < 0.05). After treatment, the serum levels of matrix metalloproteinase-9 (MMP-9), cystatin C (CysC), stromal cell derived factor-1 (TSP-1), β2-microglobulin (β2-MG) and human fibroblast growth factor-23 (FGF-23) in two groups were significantly lower than those before treatment. However, bone morphogenetic protein-7 (BMP-7) was significantly increased (P < 0.05), and the improvement was more obvious in the treatment group (P < 0.05). After treatment, coronary artery calcification (CACS) score and abdominal aortic calcification (AACS) score were significantly decreased in two groups (P < 0.05), and the improvement was more obvious in the treatment group (P < 0.05). Conclusion Lanthanum carbonate combined with levocarnitine have obvious curative effect in treatment of chronic renal failure on maintenance hemodialysis, and can effectively improve renal function, bone metabolism index, and serum cytokines, and also can delay vascular calcification, which has good clinical application value.

R975

沧州市重点研发计划指导项目(204106081)