不同方法治疗终末期肾脏病继发性甲旁亢疗效与安全性评价分析

摘要

目的 观察评价骨化三醇冲击和常规治疗终末期肾脏病继发性甲状旁腺功能亢进(SHPT)患者的疗效及安全性.方法 将28例维持性血液透析终末期肾脏病继发性SHPT患者(甲状旁腺素iPTH 500～1000 pg/ml)随机分为冲击治疗(冲击组)和常规治疗(对照组),每组14例.冲击组给予骨化三醇胶丸2～ 4μg/次,每周2次；对照组给予骨化三醇胶丸0.25μg/d维持治疗.所有患者均在透析后给予骨化三醇胶丸治疗,疗程12周,观察两组前后症状改善情况及iPTH、Ca2+、P3-、AKP的变化情况和骨化三醇的不良反应.结果 冲击治疗组皮肤瘙痒、骨痛、皮乏无力等症状明显好转,血iPTH治疗前(756.5±198.2)pg/ml、治疗后(415.2.± 158.8) pg/ml; p3-治疗前(2.12±0.32)mmol/L、治疗后(1.12±0.38) mmol/L; AKP治疗(141.2± 39.1)U/L、治疗后(108.5±31.6) U/L.三项指标明显下降.血Ca2+治疗前(1.88±0.15) mmol/L、治疗后(2.42±0.22)mmol/L,提示血Ca2+升高,但无高钙血症及严重的不良反应.上述指标差异有统计学意义(P＜0.01).常规治疗对照组症状改善不明显,血iPTH、P3-、AKP、Ca2+变化不明显,差异无统计学意义(P＞0.05).结论 骨化三醇冲击治疗维持性血液透析终末期肾脏病SHPT疗效明显优于对照组的常规治疗,安全性和患者的依从性好.%Objective To observe and evaluate the efficacy and safety of calcitriol pulse therapy (CPT) and routine therapy for patients with secondary hyperparathyroidism (SHPT) of end-stage renal disease (ESRD).Methods 28 patients with SHPT (iPTH 500 ～ 1000 pg/ml) of ESRD undergoing maintenance hemodialysis (MHD) were randomly divided into two groups:calcitriol pulse therapy group and routine therapy group (control group),14 patients for each group.The patients in the calcitriol pulse therapy group was treated with 2 ～ 4 μ g Calcitriol Soft Capsules per time,twice a week,while the patients in the routine therapy group was treated with 0.25 p g Calcitriol Soft Capsules daily.All patients were treated with Calcitriol Soft Capsules for 12 weeks after receiving hemodialysis.The improvement in symptoms,changes in levels of iPTH,Ca2+,p3-,and AKP,and adverse reactions of both groups were observed.Results The patients in the calcitriol pulse therapy group had obvious improvement in skin pruritus,bone pain,and fatigue.The level of iPTH decreased from (756.5 ± 198.2) pg/ml before the treatment to (415.2 ± 158.8) pg/ml after the treatment.The level of p3-decreased from (2.12 ± 0.32) mmol/L before the treatment to (1.12 ± 0.38) mmol/L after the treatment.The level of AKP decreased from (141.2 ± 39.1) U/L before the treatment to (108.5 ± 31.6) U/L after the treatment.The levels of iPTH,P3-and AKP decreased apparently,while the level of Ca2+ increased from (1.88 ± 0.15) mmol/L before the treatment to (2.42 ± 0.22) mmol/L after the treatment.But there were no hypercalcemia and serious adverse reactions.The differences are notable and have statistical significances (P ＜ 0.01).However the patients in the routine therapy group didn' t have obvious improvement in symptoms.The levels of iPTH,p3-,AKP,and Ca2+ didn' t change obviously.The differences didn' t have statistical significances (P ＞ 0.05).Conclusion Calcitriol pulse therapy is obviously more effective than routine therapy in treating patients with SHPT of ESRD undergoing maintenance hemodialysis and has high safety and patient compliance.