摘要
目的:探讨骨化三醇常规疗法与冲击疗法对维持性血液透析(MHD)继发性甲状旁腺功能亢进症(SHPT)患者外周血全段甲状旁腺激素(PTH)、Notch1水平和血管钙化的影响。方法:选取2019年4月至2022年4月该院收治的尿毒症行MHD治疗并发SHPT患者84例,根据随机数字表法分为常规组和观察组,每组42例。常规组患者给予骨化三醇0.25~0.50μg,观察组患者给予骨化三醇冲击疗法,持续治疗6个月。比较两组患者的临床疗效,治疗前后的临床症状,血钙、血磷、PTH水平和Notch1 mRNA水平;比较两组患者治疗前后冠状动脉钙化积分(CACS)和心脏瓣膜钙化程度;统计两组患者不良反应发生情况。结果:观察组患者的临床总有效率为95.24%(40/42),高于常规组的80.95%(34/42),差异有统计学意义(P<0.05)。治疗后,观察组患者骨痛、皮肤瘙痒、四肢无力和关节痛等症状的发生率明显低于常规组,差异均有统计学意义(P<0.05)。治疗后,观察组患者血钙水平高于常规组,血磷、PTH和Notch1 mRNA水平低于常规组,差异均有统计学意义(P<0.05)。治疗后,观察组患者CACS和心脏瓣膜钙化率低于常规组,差异均有统计学意义(P<0.05)。观察组、常规组患者不良反应发生率的差异无统计学意义(P>0.05)。结论:与常规治疗法相比,骨化三醇冲击疗法疗效明显,可改善尿毒症行MHD治疗并发SHPT患者的临床症状,有效调节钙磷代谢,抑制血管钙化,降低PTH、Notch1水平,且具有一定的安全性。
OBJECTIVE:To investigate the effects of calcitriol for conventional therapy and shock therapy on peripheral blood parathyroid hormone(PTH),Notch1 and vascular calcification in patients with secondary hyperparathyroidism(SHPT)secondary to maintenance hemodialysis(MHD).METHODS:Totally 84 uremia patients with SHPT secondary to MHD admitted into the hospital from Apr.2019 to Apr.2022 were selected to be divided into convention group and observation group via random number table method,with 42 cases in each group.The convention group was given 0.25-0.50μg of calcitriol,the observation group was given shock therapy of calcitriol,both groups were treated for 6 months.The clinical efficacy,the clinical symptoms,blood calcium,blood phosphate,PTH and Notch1 mRNA levels before and after treatment were compared between two groups;the coronary artery calcium scores(CACS)and calcification extent of cardiac valves were compared between two groups before and after treatment;the incidences of adverse drug reactions of two groups were calculated.RESULTS:The clinical total effective rate of the observation group was 95.24%(40/42),which was higher than that of the convention group(80.95%,34/42),with statistically significant difference(P<0.05).After treatment,the incidences of bone pain,cutaneous pruritus,limbs weakness and joint pain of the observation group were significantly lower than those of the convention group,with statistically significant differences(P<0.05).After treatment,the blood calcium level of the observation group was higher than that of the convention group,the blood phosphate,PTH and Notch1 mRNA levels of the observation group were lower than those of the convention group,with statistically significant differences(P<0.05).After treatment,the CACS and cardiac valve calcification rate of the observation group were lower than those of the convention group,with statistically significant differences(P<0.05).There was no statistically significant differences in the incidences of adverse drug reactions between observat
作者
王忠祥
庄雪明
张烨
宗刚军
徐东升
WANG Zhongxiang;ZHUANG Xueming;ZHANG Ye;ZONG Gangjun;XU Dongsheng(Dept.of Emergency,The 904th Hospital of Joint Logistic Support Force of PLA,Jiangsu Wuxi 214044,China)
出处
《中国医院用药评价与分析》
2023年第10期1210-1213,共4页
Evaluation and Analysis of Drug-use in Hospitals of China
基金
江苏省卫生计生委青年医学重点人才(No.QNRC2016883)。
