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重度继发性甲状旁腺功能亢进(secondaryhyperparathyroidism,SHPT)患者的临床疗效及其对骨代谢的影响.方法:选择中南大学湘雅二医院肾内科血液透析中心维持性血液透析＞6个月的重度SHPT患者30例,所有患者全段甲状旁腺激素(intact parathyroid hormone,iPTH)＞600 pg/mL;B超示甲状旁腺有1个以上结节增生;既往药物治疗无效.给予口服西那卡塞25～75 mg/d,同时服用骨化三醇0.5 μg/d.比较治疗前和治疗后血钙、血磷、iPTH以及骨代谢指标和骨密度的变化,观察患者治疗前有关的临床症状及治疗后改善情况.结果:入组30例患者,基线iPTH(1787.3±1321.0) pg/mL,血钙(2.54±0.19) mmol/L,血磷(2.06±0.15) mmol/L.治疗2周后患者血磷下降20％;iPTH治疗1个月后较服药前降低35％,3个月后降低70％;治疗1个月后血钙和血磷分别降至(2.39±0.17)和(1.56±0.50) mmol/L(P＜0.05),患者症状明显缓解,12个月后上述指标保持稳定;治疗6个月后骨代谢指标显示碱性磷酸酶、骨钙素、p胶原特殊序列水平分别较治疗前下降50％,37％和49％;患者的骨密度年下降幅度受到抑制.无严重不良反应发生.结论:西那卡塞联合小剂量骨化三醇可以改善维持性血液透析患者重度SHPT高钙、高磷及高iPTH状态,缓解临床症状,改善骨质代谢,可以作为治疗重度SHPT的选择.%Objective:To observe the clinical outcome and the effect of the combination of cinacalcet hydrochloride with low-dose calcitriol on bone metabolism in maintenance hemodialysis (MHD)patients with severe secondary hyperparathyroidism (SHPT).Methods:Thirty SHPT patients were enrolled to receive treatment of cinacalcet combined with low-dose calcitriol,with inclusion criteria as follows:maintenance on MHD＞6 months;serum intact parathyroid hormone (iPTH)＞600 pg/mL;parathyroid glands with more than 1 nodules by ultrasonography;traditional therapy with no effects.All patients were given cinacalcet 25-75 mg and 0.5 μg calcitriol daily.Serum Ca,P,iPTH,bone metabolic markers and bone density were measured before and after treatment.The clinical symptoms and their changes were recorded.Results:The baseline levels ofiPTH,Ca and P were (1787.3±1 321.0) pg/mL,(2.54±0.19) mmol/L,and (2.06±0.15) mmol/L,respectively.After 2 weeks of treatment,serum phosphorus decreased by 20％;after 1 and 3 months of treatment,iPTH decreased by 35％ and 70％.Ca and P fell to (2.39±0.17) and (1.56±0.50) mmol/L (P＜0.05),respectively.The symptoms of the patients relieved.The above indicators remained stable after 12 months.Moreover,after 6 months of treatment,the alkaline phosphatase,osteocalcin and β-cross levels were decreased by 50％,37％ and 49％,respectively.The decline in patients' bone density was inhibited.No severe adverse events were observed.Conclusion:Cinacalcet hydrochloride combined with low dose calcitriol can improve high calcium,high phosphorus and high iPTH in MHD patients with severe SHPT,relieve symptoms,and improve bone metabolism.It can be used as a favorable choice for the treatment of SHPT.
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