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dzb-enter-heng-desc-box\">\r\n <span class=\"dzb-special-title-box\"><\/span>\r\n <h2 class=\"dzb-title-box\">规范管控肾病“钙磷乱”<\/h2>\r\n <span class=\"dzb-sub-title-box\"><\/span>\r\n \r\n <p class=\"dzb-desc-box\"> “医生，我身上痒得整晚睡不着。”“我这骨头酸疼，走路翻身都费劲。”“脉压差越来越大，医生说我是血管钙化，血管硬邦邦没了弹性。”这些在肾内科诊室反复出现的主诉，背后往往指向同一个“元凶”——慢性肾脏病—矿物质骨代谢异常，以往称之为钙磷代谢紊乱，在尿毒症透析患者中尤为常见。<br\/><br\/> 健康的肾脏精确调节钙磷水平，维持钙磷平衡。但当肾功能下降，尤其是进入肾病终末期（俗称“尿毒症”）时，肾脏排磷能力大大降低。血液中的磷不断蓄积，身体为维持平衡不得不通过升高甲状旁腺素（PTH）从骨骼中“借”出钙。结果却因“矫枉过正”导致血磷更高、血钙紊乱，进而引发全身性损害。<br\/><br\/> 钙磷代谢紊乱的危害主要体现在三个方面：首先是皮肤瘙痒很顽固，高血磷和异常升高的甲状旁腺素会刺激皮肤的末梢神经，导致难以忍受的痒感，夜间尤甚。其次是骨骼病变，身体为降低血磷、升高血钙，不断从骨骼“借”钙，导致骨密度下降、骨骼变得脆弱，患者常莫名地感到骨痛、关节酸痛，甚至轻微碰撞就可能骨折。最后也是最危险的——血管钙化，升高的血钙磷沉积在血管壁上使其失去弹性、变得僵硬狭窄，直接增加心梗和脑卒中的风险。很多肾友最终倒在了这类心脑血管并发症上。<br\/><br\/> 面对钙磷代谢紊乱，规范管控需要同时驾驭好“四驾马车”。<br\/><br\/> ●低磷饮食建议每日摄入磷控制在800—1000毫克以内。控制坚果、奶制品、动物内脏等天然高磷食物；尤其避开加工食品、饮料、速食等含磷添加剂的食物，这类“无机磷”吸收率极高；同时学会看食品成分表，凡是带“磷”字的尽量少吃。<br\/><br\/> ●合理使用降磷药物磷结合剂的作用是在肠道里“抓住”食物中的磷，使之随粪便排出，因此必须随餐服用。药物选择上，传统含钙的磷结合剂可能加重血管钙化，非含钙的磷结合剂相对更安全，具体需遵医嘱选用。<br\/><br\/> ●控制继发性甲状旁腺功能亢进继发性甲旁亢是钙磷紊乱恶化的核心推手：当血磷升高、血钙降低时，会刺激甲状旁腺过度分泌甲状旁腺素，而这种激素又会反过来加速骨骼释放钙磷，形成恶性循环。通过动态调整活性维生素D及其类似物、拟钙剂等药物控制甲状旁腺功能亢进，预防异位钙化的发生。<br\/><br\/> ●保证规律充分的透析对于已经开始透析的尿毒症患者，足够的透析时长和频率至关重要，血透患者使用高通量透析器、联合血液透析滤过等模式能提高磷清除效率。<br\/><br\/> 肾病患者透析阶段的靶目标是，血钙、血磷在正常水平，全段甲状旁腺激素检测值维持在正常值上限的2—9倍。需强调的是，每位患者血钙、血磷、甲状旁腺素水平，以及是否合并血管钙化，均有个体差异，因此治疗方案必须由医生根据个人情况量身定制，切莫照搬他人方案或自行调整。<br\/><br\/> 当肾病患者出现不明原因的皮肤瘙痒、骨痛时，务必警惕钙磷紊乱。一旦发生“钙磷乱”，让这“四驾马车”并驾齐驱，协同发力，才能实现全方位、个体化的有效管理，远离瘙痒、骨痛的折磨，守护好心脑血管生命线。钱璟陈靖<br\/><br\/> （复旦大学附属华山医院肾病科）<br\/><br\/><\/p>\r\n <\/div>\r\n <\/div>\r\n <\/div>\r\n \r\n <div class=\"dzb-multi-btn-box\">\r\n <p class=\"dzb-multi-zoomOut dzb-multi-btn-hover\"><a href=\"javascript:;\"><img src=\"\/dianzibao\/images\/btn_A.png\"\n\n alt=\"\">放大<\/a><\/p>\n\n<p class=\"dzb-multi-zoomIn dzb-multi-btn-hover hide\"><a href=\"javascript:;\"><img src=\"\/dianzibao\/images\/btn_A.png\" 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class=\"dzb-enter-desc-box dzb-enter-heng-desc-box\">\r\n <span class=\"dzb-special-title-box\"><\/span>\r\n <h2 class=\"dzb-title-box\">规范管控肾病“钙磷乱”<\/h2>\r\n <span class=\"dzb-sub-title-box\"><\/span>\r\n \r\n <p class=\"dzb-desc-box\"> “医生，我身上痒得整晚睡不着。”“我这骨头酸疼，走路翻身都费劲。”“脉压差越来越大，医生说我是血管钙化，血管硬邦邦没了弹性。”这些在肾内科诊室反复出现的主诉，背后往往指向同一个“元凶”——慢性肾脏病—矿物质骨代谢异常，以往称之为钙磷代谢紊乱，在尿毒症透析患者中尤为常见。<br\/><br\/> 健康的肾脏精确调节钙磷水平，维持钙磷平衡。但当肾功能下降，尤其是进入肾病终末期（俗称“尿毒症”）时，肾脏排磷能力大大降低。血液中的磷不断蓄积，身体为维持平衡不得不通过升高甲状旁腺素（PTH）从骨骼中“借”出钙。结果却因“矫枉过正”导致血磷更高、血钙紊乱，进而引发全身性损害。<br\/><br\/> 钙磷代谢紊乱的危害主要体现在三个方面：首先是皮肤瘙痒很顽固，高血磷和异常升高的甲状旁腺素会刺激皮肤的末梢神经，导致难以忍受的痒感，夜间尤甚。其次是骨骼病变，身体为降低血磷、升高血钙，不断从骨骼“借”钙，导致骨密度下降、骨骼变得脆弱，患者常莫名地感到骨痛、关节酸痛，甚至轻微碰撞就可能骨折。最后也是最危险的——血管钙化，升高的血钙磷沉积在血管壁上使其失去弹性、变得僵硬狭窄，直接增加心梗和脑卒中的风险。很多肾友最终倒在了这类心脑血管并发症上。<br\/><br\/> 面对钙磷代谢紊乱，规范管控需要同时驾驭好“四驾马车”。<br\/><br\/> ●低磷饮食建议每日摄入磷控制在800—1000毫克以内。控制坚果、奶制品、动物内脏等天然高磷食物；尤其避开加工食品、饮料、速食等含磷添加剂的食物，这类“无机磷”吸收率极高；同时学会看食品成分表，凡是带“磷”字的尽量少吃。<br\/><br\/> ●合理使用降磷药物磷结合剂的作用是在肠道里“抓住”食物中的磷，使之随粪便排出，因此必须随餐服用。药物选择上，传统含钙的磷结合剂可能加重血管钙化，非含钙的磷结合剂相对更安全，具体需遵医嘱选用。<br\/><br\/> ●控制继发性甲状旁腺功能亢进继发性甲旁亢是钙磷紊乱恶化的核心推手：当血磷升高、血钙降低时，会刺激甲状旁腺过度分泌甲状旁腺素，而这种激素又会反过来加速骨骼释放钙磷，形成恶性循环。通过动态调整活性维生素D及其类似物、拟钙剂等药物控制甲状旁腺功能亢进，预防异位钙化的发生。<br\/><br\/> ●保证规律充分的透析对于已经开始透析的尿毒症患者，足够的透析时长和频率至关重要，血透患者使用高通量透析器、联合血液透析滤过等模式能提高磷清除效率。<br\/><br\/> 肾病患者透析阶段的靶目标是，血钙、血磷在正常水平，全段甲状旁腺激素检测值维持在正常值上限的2—9倍。需强调的是，每位患者血钙、血磷、甲状旁腺素水平，以及是否合并血管钙化，均有个体差异，因此治疗方案必须由医生根据个人情况量身定制，切莫照搬他人方案或自行调整。<br\/><br\/> 当肾病患者出现不明原因的皮肤瘙痒、骨痛时，务必警惕钙磷紊乱。一旦发生“钙磷乱”，让这“四驾马车”并驾齐驱，协同发力，才能实现全方位、个体化的有效管理，远离瘙痒、骨痛的折磨，守护好心脑血管生命线。钱璟陈靖<br\/><br\/> （复旦大学附属华山医院肾病科）<br\/><br\/><\/p>\r\n <\/div>\r\n <\/div>\r\n <\/div>\r\n \r\n <div class=\"dzb-multi-btn-box\">\r\n <p class=\"dzb-multi-zoomOut dzb-multi-btn-hover\"><a href=\"javascript:;\"><img src=\"\/dianzibao\/images\/btn_A.png\"\n\n alt=\"\">放大<\/a><\/p>\n\n<p class=\"dzb-multi-zoomIn dzb-multi-btn-hover hide\"><a href=\"javascript:;\"><img src=\"\/dianzibao\/images\/btn_A.png\" 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window.open('http:\/\/service.weibo.com\/share\/share.php?searchPic=false&url='+document.location.href+'&title='+ftit+'&pic='+lk,'','width=700, height=680, top=0, left=0, toolbar=no, menubar=no, scrollbars=no, location=yes, resizable=no, status=no');\n\n }\n\n }\n\n layui.config({\n\n base: \"js\/\"\n\n }).use('laydate', function () {\n\n const layer = parent.layer === undefined ? layui.layer : parent.layer,form = layui.form;\n\n const laydate = layui.laydate;\n\n laydate.render({\n\n elem: '#wangqi',\n\n showBottom: false,\n\n position: 'static',\n\n format: 'yyyy-MM-dd',\n\n ready:function(date){\n\n $('.layui-laydate-content tr td').addClass('laydate-disabled');\n\n const elem = $(this.elemCont);\n\n $.ajax({\n\n url:\"\/\/paper.xinmin.cn\/index\/api.Getdate\/index\",\n\n cache:\"false\",\n\n data:{'name':'xmwb'},\n\n type:\"POST\",\n\n dataType:\"json\",\n\n success:function(data){\n\n if(data.status == 1){\n\n const dateArr = data.msg;\n\n for(let i=0;i<dateArr.length;i++){\n\n 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