目的 探討醋酸鈣片聯(lián)合碳酸鑭咀嚼片治療尿毒癥血液透析患者高磷血癥的臨床療效。方法 選取2014年8月-2016年9月在青島市市立醫(yī)院進(jìn)行尿毒癥血液透析高磷血癥患者134例，根據(jù)血磷水平隨機(jī)分為醋酸鈣組（43例）、碳酸鑭組（45例）、醋酸鈣和碳酸鑭聯(lián)合組（46例）。醋酸鈣組口服醋酸鈣片，2片/次，3次/d；碳酸鑭組口服碳酸鑭咀嚼片，2片/次，3次/d；聯(lián)合組口服碳酸鑭咀嚼片、醋酸鈣片，2片/次，3次/d。3組患者均持續(xù)治療12周。觀察各組的臨床療效，比較各組的觀察指標(biāo)。結(jié)果 碳酸鑭組總有效率（75.5%）高于醋酸鈣組（69.7%），但差異無統(tǒng)計(jì)學(xué)意義。聯(lián)合組總有效率（94.5%）高于醋酸鈣組、碳酸鑭組，差異均具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，各組血磷、血甲狀旁腺素（PTH）均顯著降低，碳酸鑭組血鈣、冠狀動脈鈣化積分（CACs）降低，醋酸鈣組、聯(lián)合組血鈣、CACs升高，與同組治療前比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，與醋酸鈣組比較，碳酸鑭組、聯(lián)合組的血磷、血鈣、血PTH、CACs均降低，差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；與碳酸鑭組比較，聯(lián)合組的血磷、血PTH降低，血鈣、CACs升高，差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 碳酸鑭和醋酸鈣均能有效降低血磷，但碳酸鑭對血鈣的影響較小，并能明顯延緩CACs的進(jìn)展。碳酸鑭聯(lián)合醋酸鈣控制血磷效果最好，但有增加CAC的進(jìn)展的風(fēng)險，有待于進(jìn)一步研究。

Objective To explore the clinical effect of Calcium Acetate Tablets combined with Lanthanum Carbonate Chewable Tablets in treatment of hyperphosphatemia in patients with uremic hemodialysis. Methods Patients (134 cases) with uremic hemodialysis in Qingdao Municipal Hospital (Group) from August 2014 to September 2016 were enrolled in this study. According to the serum phosphorus level, patients were divided into calcium acetate group (43 cases), lanthanum carbonate group (45 cases), and combine treatment group (46 cases). The patients in the calcium acetate group were po administered with Calcium Acetate Tablets, 2 tablets/time, three times daily. The patients in the lanthanum carbonate group were po administered with Lanthanum Carbonate Chewable Tablets, 2 tablets/time, three times daily. The patients in the combination group were po administered with Calcium Acetate Tablets and Lanthanum Carbonate Chewable Tablets, 2 tablets/time, three times daily. Patients in three groups were treated for 12 weeks. After treatment, the clinical efficacies were evaluated, and observation indexes among groups were compared. Results After treatment, the clinical efficacies in the calcium acetate and lanthanum carbonate groups were 75.5% and 69.7%, respectively, but clinical efficacy (94.5%) in the combination group were higher than those in two groups, and there was difference between two groups (P<0.05). After treatment, the levels of serum phosphorus and serum PTH were decreased, and serum calcium and CACs in lanthanum carbonate group were decreased, but the serum calcium level and calcium in calcium acetate group and combination group were increased, and the difference was statistically significant in the same group (P<0.05). After treatment, the levels of blood phosphorus, blood PTH, serum calcium and CACs in lanthanum carbonate group and combination group were higher than those in calcium acetate group, and the differences were statistically significant (P<0.05). Compared with lanthanum carbonate group, the levels of blood phosphorus and PTH were decreased, but blood calcium and CACs were increased in lanthanum carbonate group, the differences were statistically meaning (P<0.05). Conclusion Lanthanum carbonate or calcium acetate has clinical curative effect in treatment of hyperphosphatemia in patients with uremic hemodialysis, can significantly reduce the levels of serum phosphorus, but lanthanum carbonate has little effects on calcium and can delay the progress of CACs. The effect of calcium carbonate combined with calcium acetate are the best on the control of serum phosphorus, but the risk of the development of CAC is increased, which is worthy of further discussion.