摘要
目的：探讨骨化三醇、西那卡塞联合护理干预对维持性血液透析（MHD）患者继发性甲状旁腺功能亢进（SHPT）血清成纤维细胞生长因子23（FGF23）的影响。方法：选取我院收治的SHPT患者90例为研究对象,随机分为观察组和对照组。两组均给予护理干预,于进食时吞服盐酸西那卡塞,开始剂量为25mg/d,每2～4周根据全段甲状旁腺激素（iPTH）、钙（Ca）、磷（P）水平调整剂量,最大剂量不超过75mg/d,观察组在上述治疗基础上口服骨化三醇胶丸0.25μg/d,3次/周,两组均治疗3个月后进行效果评价。两组治疗前后采集清晨空腹外周静脉血,采用比色法测定Ca、P,ELISA法测定iPTH及血清FGF23、骨特异性碱性磷酸酶（BSAP）,全自动生化检测仪测定血肌酐（Scr）、尿毒氮（BUN）,单室尿素动力学模型进行量化分析检测尿素清除指数（KT/V）。结果：观察组治疗后Ca升高程度,P、iPTH降低程度大于对照组（P〈0.05）,两组治疗后BUN、Scr、KT/V无明显变化（P〉0.05）,观察组治疗后FGF23、BSAP水平降低程度大于对照组（P〈0.05）。结论：骨化三醇、西那卡塞联合护理干预治疗MHD患者SHPT,可有效降低PTH、FGF23、BSAP水平,改善临床症状。
Objective.. To investigate calcitriol, cinacalcet combined with nursing intervention on secondary hyperpara- thyroidism （SHPT） serum fibroblast growth factor 23 （FGF23） in maintenance hemodialysis （MHD） patients. Methods： 90 cases of SHPT treated in our hospital were selected and randomly divided into the observation group and the control group. The 2 groups were given nursing intervention on cinacalcet hydrochloride swallow when eating, starting dose is 25 mg/d, every 2 to 4 weeks according to the parathyroid hormone （iPTH）, calcium （Ca）, phosphorus （P） level adjustment dose, the maximum dose of was less than 75 mg/d, the observation group was treated with basic treatment in the Calcitriol Soft Capsules 0.25 g/d, 3 times / week, the effect of the 2 groups after 3 months of treatment was evaluated. Before and after treatment collected fast- ing peripheral venous blood, Ca, P were measured by colorimetric method, determination of iPTH and FGF23 in the serum and bone specific alkaline phosphatase ELISA （BSAP）, serum creatinine automatic biochemistry analyzer （Scr）, nitrogen（BUN）, uremic quantitative detection and analysis of urea clearance index of single room urea kinetic model （KT/V）. Results： Level of Ca, P of the observation group after treatment increased but iPTH decreased comparing with that of control group （P 〈0.05）, the BUN, Scr and KT/V showed no significant change after treatment in both groups （P〈0.05）. After treatment, FGF23 and BSAP levels in observation group decreased comparing with the control group （P〈0.05）. Conclusion： Calcitriol, cinacalcet combined with nursing intervention can effectively reduce the PTH, FGF23, BSAP levei in the treatment of MHD patients with SHPT, it can also improve the clinical symptoms.
出处
《海南医学院学报》
CAS
2016年第24期2993-2995,2998,共4页
Journal of Hainan Medical University
基金
张家口市科学技术和地震局计划项目(1521095D)~~
