摘要
目的探讨西那卡塞联合小剂量骨化三醇治疗维持性血液透析(MHD)合并继发性甲状旁腺功能亢进(SHPT)的疗效观察。方法选取本院肾病中心2012年8月至2017年8月收治的80例MHD合并SHPT患者,采用随机数字表法将其分为骨化三醇组和联合治疗组,每组各40例。骨化三醇组采用骨化三醇治疗,联合治疗组采用西那卡塞联合小剂量骨化三醇治疗,疗程为12个月,监测患者治疗6个月和12个月前后的血钙、血磷、血全段甲状旁腺激素(iPTH)、碱性磷酸酶(ALP)水平。结果两组患者经6个月和12个月的治疗,iPTH水平较入组时均有下降(均P<0.05),12个月时联合治疗组的下降幅度最大。骨化三醇组的钙、磷水平较入组前均明显升高(均P<0.05),联合治疗组的血磷较入组前明显下降(P<0.05),而血钙及ALP与入组前比较,差异均无统计学意义(均P>0.05)。骨化三醇组出现7例高钙血症,联合治疗组未出现高钙、低钙血症。所有入组患者均未出现明显的胃肠道不良反应。骨化三醇组发生3例恶心呕吐,1例头痛;联合治疗组发生1例恶心呕吐,1例食欲不振,1例腹痛,两组患者的不良反应总发生率分别为10.0%、7.5%,差异无统计学意义(P>0.05)。结论对于MHD合并SHPT患者采用西那卡塞联合小剂量骨化三醇治疗较骨化三醇单独用药效果更好。
Objective To investigate the clinical efficacy of cinacalcet combined with low-dose calcitriol in the treatment of secondary hyperparathyroidism(SHPT)in maintenance hemodialysis patients.Methods From August 2012 to August 2017,80 patients with MHD and SHPT in our hospital were selected.The patients were randomly divided into the calcitriol group(40 cases)and the combination therapy group(40 cases).The control group was treated with calcitriol,and the observation group was treated with xenacax combined with low-dose calcitriol for 12 months.Blood calcium,blood phosphorus,whole parathyroid hormone(iPTH)and alkaline phosphatase(ALP)levels were monitored before and after 6 months and 12 months of treatment.Results After 6 or 12 months of treatment,the serum levels of parathyroid hormone were decreased in two groups(all P<0.05).The combination therapy group had the largest decline at 12 months.The parathyroid hormone decreased more markedly with less influence on serum calcium in combination therapy group while serum calcium and phosphorus were obviously increased in calcitriol group(P<0.05).There were no significant changes in alkaline phosphatase between two groups after treatment(P>0.05).There were 7 cases of hypercalcemia in the calcitriol group,but no hypercalcemia or hypocalcemia in the combined treatment group.None of the enrolled patients had obvious gastrointestinal adverse reactions.Three cases of nausea and vomiting and 1 case of headache occurred in calcitriol group.There was 1 case of nausea and vomiting,1 case of anorexia and 1 case of abdominal pain in the combined treatment group.The total incidence of adverse reactions in the two groups was 10.0%and 7.5%,respectively,with no statistical significance(P>0.05).Conclusions The study shows that the combined use of cinacalcet and low-dose calcitriol has better therapeutic effect for treatment of SHPT with MHD.
作者
端颖
陈晓霞
Duan Ying;Chen Xiaoxia(Department of Blood purification Center,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing 210006,China)
出处
《国际泌尿系统杂志》
2022年第1期86-89,共4页
International Journal of Urology and Nephrology
基金
南京医科大学青年科学基金项目(81902602)。
