摘要
目的观察盐酸西那卡塞联合小剂量骨化三醇治疗维持性血液透析患者中重度继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)的疗效及安全性。方法采用单中心前瞻性观察本院血液净化中心2017年3月至2018年3月期间收治的西那卡塞联合小剂量骨化三醇治疗中重度继发性甲状旁腺功能亢进症患者15例,观察患者治疗过程中临床症状,监测用药后1、2、4、8、12周的血清钙、磷、甲状旁腺激素(iPTH)及碱性磷酸酶等指标的变化,同时观察治疗前及治疗12周后患者血钙、血磷及血iPTH达标情况。结果15例患者中有1例患者因出现难以耐受的消化道症状而退出使用,2例iPTH>3000 pg/ml的患者疗效不佳后行甲状旁腺切除术。其余12例患者一般治疗的有效剂量为每天50 mg,起效时间多为1~2个月,维持剂量约为每天25 mg。此12例患者治疗前及治疗12周后血iPTH及血钙、血磷水平均有显著下降,差异有统计学意义(血清iPTH:F=10.808,P=0.001;血钙:F=7.516,P=0.003;血磷:F=9.723,P=0.001),血清碱性磷酸酶水平治疗前后差异无统计学意义。予以西那卡塞治疗后患者血钙、血磷达标率增加,骨痛、皮肤瘙痒等临床症状明显改善,3例患者有消化道症状但可耐受,无严重低钙血症等不良反应发生。结论西那卡塞联合小剂量骨化三醇可有效降低中重度SHPT患者的血iPTH、血钙、血磷等指标及改善临床症状,但部分重度SHPT患者效果较差,大部分患者不良反应轻微。
Objective To observe the efficacy and safety of cinacalcet combined with small dose of calcitriol for the treatment on moderate to severe secondary hyperparathyroidism in hemodialysis patients.Methods Used single center prospective study,15 cases of moderate to severe SHPT patients after hemodialysis in our hospital from March 2017 to March 2018 were selected.Efficacy of the treatment was evaluated by changes of serum calcium(Ca),phosphorus(P),intact parathyroid hormone(iPTH)and alkaline phosphatase(AKP)and clinical symptom before and after cinacalcet combined with small dose of calcitriol therapy for 1,2,4,8,12 weeks,at the same time,the patient's blood calcium,blood phosphorus and blood iPTH were observed before treatment and after 12 weeks of treatment.Results 1 case of the 15 patients withdrew from the study because of intolerable gastrointestinal symptoms,2 cases of the 15 patients whose iPTH>3000 pg/ml underwent parathyroidectomy because of poor curative effect,serum iPTH,Ca,P of 12 remaining patients decreased significantly(serum iPTH:F=10.808,P=0.001;serum Ca:F=7.516,P=0.003;serumP:F=9.723,P=0.001),serum AKP had no significant difference.The propotion of patients achieving the target calcium and phosphorus increased significantly after the treatment of cinacalcet(P<0.05).Patients with bone pain,skin itching and other symptoms improved significantly,3 cases of the 12 patients with gastrointestinal symptoms but can be tolerated,no serious side effects such as hypocalcemia.Conclusion Cinacalcet combined with small dose of calcitriol can significantly decreased the serum iPTH,Ca,P of the patients with moderate to severe secondary hyperparathyroidism and improve clinical symptoms,however,it has poor efficacy for some patients with severe SHPT,and most of the patients have mild adverse reactions.
作者
唐利
张家丽
廖常彬
Tang Li;Zhang Jiali;Liao Changbin(Department of Nephrology,Zigong Third People's Hospital,Zigong,Sichuan,643000,China)
出处
《当代医学》
2019年第32期20-23,共4页
Contemporary Medicine
基金
自贡市2016年度卫生计生系统科研立项课题(2016ZC06)
