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目的:比较碳酸镧与醋酸钙治疗维持性血液透析患者高磷血症的效果。方法:选取2016年3月至2017年1月义乌市中心医院肾内科因慢性肾衰竭行血液透析患者202例，纳入研究的患者透析龄≥6个月，透析前血磷>1.78 mmol/L，采用随机数字表法将其分为碳酸镧组及醋酸钙组，醋酸钙组100例，碳酸镧组102例，其中碳酸镧组2例因不能耐受呕吐退出研究，治疗时间为9个月。研究期间合理使用低钙透析液并严格限磷饮食，比较两组间及两组内治疗前后血磷、血钙、甲状腺旁腺素（iPTH）的变化。结果:治疗中，碳酸镧组服用磷结合剂的剂量平均为1 500 mg/d，而醋酸钙组为 3 335 mg/d。两组治疗前一般人口学资料和生化指标等基线资料差异均无统计学意义（均n P>0.05）。随访发现，两组患者饮食中的磷含量差异无统计学意义（n P>0.05），血液透析液的钙浓度差异无统计学意义（n P>0.05）。醋酸钙组血磷从治疗前的（2.12±0.35）mmol/L下降至（1.55±0.24）mmol/L（n t=13.43，n P 1.78 mmol/L before dialysis. They were randomly divided into the lanthanum carbonate ( n n = 100) and calcium acetate (n n =102) groups. Two patients in the lanthanum carbonate group withdrew from the study due to intolerance of vomiting. All patients were treated for 9 months. During the study period, low calcium dialysate was rationally used, and strict dietary phosphate restriction was applied. The changes in serum phosphorus, calcium and parathyroid hormone contents before and after treatment were compared between the two groups, and they were compared between before and after treatment in each group.n Results:During the treatment, the average dose of phosphate binder was 1 500 mg/d in the lanthanum carbonate group and 3 335 mg/d in the calcium acetate group. There were no significant differences in general demographic data and biochemical indexes between the two groups (both n P > 0.05). No significant differences in dietary phosphorus content and dialysate calcium concentration were observed between the two groups (both n P > 0.05). In the calcium acetate group, blood phosphorus content decreased from (2.12 ± 0.35) mmol/L before treatment to (1.55 ± 0.24) mmol/L after treatment ( n t = 13.43, n P < 0.01). In the lanthanum carbonate group, blood phosphorus content decreased from (2.14 ± 0.3) mmol/L before treatment to (1.45 ± 0.17) mmol/L after treatment ( n t = 20.01, n P < 0.01). In the lanthanum carbonate group, the difference in blood phosphorus content between before and after treatment was (0.69 ± 0.29) mmol/L, which was significantly higher than that in the calcium acetate group [(0.57 ± 0.37) mmol/L, n t = 2.553, n P 0.05).n Conclusion:Under the premise of effectively implementing rational low calcium dialysate use and strict dietary phosphate restriction, both calcium acetate and lanthanum carbonate can effectively reduce the blood phosphorus level in patients undergoing maintenance hemodialysis. Lanthanum carbonate has better effect in reducing serum phosphorus level than calcium acetate, but it is likely to produce gastrointestinal reactions. Neither treatment method bears the risk of hypercalcemia.