摘要
目的观察西那卡塞联合骨化三醇注射液治疗维持性血液透析(maintenance hemodialysis,MHD)患者中重度继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)的效果及安全性。方法选择2017年1月—2020年1月在我院血液透析室行MHD治疗的中重度SHPT患者48例,根据治疗方法不同分为观察组与对照组各24例。对照组予骨化三醇注射液治疗,观察组在上述治疗基础上加用西那卡塞治疗。连续治疗6个月后,观察两组血全段甲状旁腺激素(iPTH)、钙(Ca)、磷(P)、碱性磷酸酶(ALP)、β-Ⅰ型胶原C-末端肽(β-CTX)、Ⅰ型前胶原N-端前肽(PⅠNP)变化和iPTH、Ca、P达标情况及甲状旁腺体积,并观察两组治疗期间不良反应发生情况。结果治疗后对照组血Ca较治疗前升高(P<0.05),观察组血Ca无明显变化(P>0.05);治疗后两组血P、iPTH、ALP、β-CTX及PⅠNP较治疗前明显下降(P<0.01);治疗后观察组较对照组血Ca、P、iPTH、ALP、β-CTX及PⅠNP下降明显,差异有统计学意义(P<0.05或P<0.01)。治疗后观察组iPTH、Ca、P达标率明显高于对照组(P<0.05)。治疗后,对照组甲状旁腺体积无明显变化(P>0.05),观察组甲状旁腺体积缩小(P<0.01),且观察组甲状旁腺体积小于对照组(P<0.01)。两组治疗期间不良反应比较差异无统计学意义(χ^2=0.105,P=0.745)。结论西那卡塞联合骨化三醇注射液治疗MHD患者中重度SHPT效果显著,可降低血清iPTH水平及改善钙磷代谢紊乱和骨代谢异常,缩小甲状腺体积,且安全性好。
Objective To observe the effect and safety of cinacalcet combined with calcitriol injection in the treatment of moderate to severe secondary hyperparathyroidism(SHPT)in patients undergoing maintenance hemodialysis(MHD).Methods Forty-eight patients with moderate to severe SHPT who were treated with maintenance hemodialysis in Dialysis Center of our hospital from January 2017 to January 2020,were randomly divided into observation group(n=24)and control group(n=24)according to different treatment methods.The control group was given calcitriol injection,and in the observation group was given cinacalcet combined with calcitriol injection.After continuous treatment for 6 months,we observed the change of serum total iPTH,serum calcium(Ca),serum phosphorus(P),the alkaline phosphatase(ALP),β-Ⅰcollagen C-terminal peptide(β-CTX),Ⅰprocollagen amino-terminal propeptide(PⅠNP),compliance status of parathyroid gland volume,and observed adverse reactions in the two groups during treatment.Results After treatment,the level of Ca in the control group was increased compared with that before treatment(P<0.05),while Ca was not significantly changed in the observation group(P>0.05).The level of P,iPTH,ALP,β-CTX and PⅠNP in the two groups after treatment were significantly decreased(P<0.01).In the observation group,the level of Ca,P,iPTH,ALP,β-CTX and PⅠNP were significantly decreased compared with the control group(P<0.05 or P<0.01).The compliance rates of iPTH,Ca and P in the observation group after treatment were significantly higher than those in the control group(P<0.05).After treatment,the volume of parathyroid gland in the control group was not significantly changed(P>0.05),but was reduced in the observation group(P<0.01),and the volume of parathyroid gland in the observation group was smaller than that in the control group(P<0.01).There was no significant difference in the incidence of adverse reactions between the observation group and the control group(χ^2=0.105,P=0.745).Conclusion The combination of cinacalcet and calcitriol injection has a significant effect in the treatment of moderate to severe SHPT,which can reduce serum iPTH level,improve calcium and phosphorus metabolism disorder and abnormal bone metabolism,and reduce thyroid volume.Moreover,it has a good safety.
作者
徐彩棉
夏国宏
李轶洁
王美玲
徐杨
XU Cai-mian;XIA Guo-hong;LI Yi-jie;WANG Mei-ling;XU Yang(Beijing Hepingli Hospital,Dialysis Center,Beijing 100013,China;Beijing Hepingli Hospital,Department of Nephrology,Beijing 100013,China)
出处
《临床误诊误治》
CAS
2021年第2期19-24,共6页
Clinical Misdiagnosis & Mistherapy
基金
北京市医院管理局项目(PX2019022)。
