·论著·HMB对终末期肾病血液透析患者钙磷代谢紊乱的疗效观察梁清月，王仲，宗雪萍，刘菲，李轰烈（成都市第五人民医院临床营养科，成都611130）摘要：目的观察和评价对血液净化的终末期肾病患者使用β‐羟基‐β‐甲基丁酸（HMB）对其钙磷代谢紊乱的治疗效果。
方法选取2018年3月至2019年8月在成都市第五人民医院接受血液透析治疗的64例终末期血透肾病患者作为研究对象，采用随机对照设计，将其分为试验组与对照组，每组32例。
两组均采用常规血液净化治疗，试验组予以HMB进行干预，对照组予以安慰剂，共12周。
观察患者治疗前后实验室指标的变化，包括血清钙、磷、甲状旁腺激素、尿素氮、肌酐、血清白蛋白、前白蛋白、血红蛋白。
结果①钙磷代谢紊乱实验室结果：与治疗前比较，试验组干预后血清磷、甲状旁腺激素降低，血清钙升高，疗效优于对照组（P<0.05）。
②肾功能指标结果：与治疗前比较，试验组干预后尿素氮、肌酐降低，疗效优于对照组（P<0.05）。
③营养状况指标结果：与治疗前比较，试验组干预后白蛋白、前白蛋白升高，疗效优于对照组（P<0.05）；血红蛋白干预前后试验组与对照组无明显改变（P>0.05）。
结论对终末期肾病血液透析患者补充HMB，能够有效调节患者的钙磷代谢紊乱，改善患者肾功能及营养状况，延缓相关并发症的发生。
关键词：β‐羟基‐β‐甲基丁酸；钙磷代谢紊乱；终末期肾病Clinical study on the effect of HMB on disorder of calcium and phosphorus metabolism in blood purification patients with end‑stage renal diseaseLiang Qingyue,Wang Zhong,Zong Xueping,Liu Fei,Li HonglieDepartment of Clinical Nutrition,the Chengdu Fifth People′s Hospital,Chengdu611130,Sichuan,ChinaAbstract:Objective To observe and evaluate the effect of combinedβ⁃hydroxy⁃methylbutyric acid(HMB)in blood purification patients with end⁃stage renal disease,to explore more effective methods and approaches to prevent and cure the disorder of calcium and phosphorus metabolism in end⁃stage renal disease.Methods From March2018to August2019,64 patients with end⁃stage renal disease who received blood purification,it was divided into experimental group and control group with32cases in each group,with random control design.Both groups were treated with routine blood purification.HMB intervention was performed in the trial group and placebo in the control group,which for a total duration of12weeks.To observe changes in laboratory indicators before and after treatment,including:serum calcium,phosphate,intact parathyroid hormone,urea nitrogen,serum creatinine,serum albumin and prealbumin,hemoglobin.Results(1)Laboratory results of calcium and phosphorus metabolism disorders:compared with pre⁃treatment,serum phosphorus and parathyroid hormone decreased after intervention in the experimental group,serum calcium elevated,the curative effect was better than the control group(P<0.05).(2) Results of renal function index:compared with pre⁃treatment,the serum Cr,BUN were decreased in the treatment group,and the curative effect was better than the control group(P<0.05).(3)Nutritional status indicators:compared with pre⁃treatment,the albumin and prealbumin increased after the intervention,the curative effect was better than the control group(P<0.05);There was no significant change between the experimental group and the control group before and after hemoglobin intervention(P>0.05). Conclusions Adding HMB,in blood purification patients with end⁃stage renal disease,it can effectively regulate the disorder of calcium and phosphorus metabolism,improve improve the renal function and the nutritional status of patients,and delay the occurrence of related complications.Key words:β⁃hydroxy⁃β⁃methylbutyric;Calcium and phosphorus metabolism disorder;End⁃stage renal disease终末期肾病（end stage renal disease,ESRD）是慢性肾脏病（chronic kidney disease,CKD）所致肾脏结构、功能异常持续3个月或以上时间，是不可逆的肾脏衰竭终末阶段［1］或肾小球滤过率（glomerular filtration rate,GFR）<15ml/(min·1.73m2）需要肾脏替代治疗的CKD［2］，发病率呈逐年升高趋势［3］，ESRD预后差治疗费用高［4］，目前已成为全球性公共卫生问题［5］。
