骨化三醇、西那卡塞联合综合干预对MHD患者SHPT钙、磷代谢及甲状旁腺激素的影响

摘要

目的:探讨骨化三醇、西那卡塞联合综合干预对维持性血液透析(MHD)患者继发性甲状旁腺功能亢进(SHPT)钙(Ca)、磷(P)代谢及甲状旁腺激素(PTH)的影响.方法:选取我院收治的SHPT患者80例为研究对象,随机分为观察组和对照组,对照组于进食时整片吞服盐酸西那卡塞片,初始剂量为25 mg/d,每2~4周根据Ca、P、全段甲状旁腺激素(iPTH)检测结果调整剂量,最大剂量不超过75 mg/d,观察组在对照组基础上口服骨化三醇胶丸 0.25 μg/d,3次/周,两组均给予综合干预措施,治疗3个月后进行疗效评价.两组治疗前后采集清晨空腹外周静脉血,采用比色法测定Ca、P、碱性磷酸酶(ALP)水平,计算Ca、P乘积(Ca×P),ELISA法检测iPTH水平;治疗前后采用TY-6858-HI型B超仪,测量甲状旁腺长、宽、厚度,并计算甲状旁腺体积.结果:观察组治疗后Ca、Ca×P升高程度,P、ALP、iPTH降低程度优于对照组(P<0.05),甲状旁腺体积缩小程度优于对照组(P<0.05).结论:骨化三醇、西那卡塞联合综合干预治疗MHD 患者SHPT具有较好的临床效果,可有效改善Ca、P代谢,降低iPTH水平,缩小甲状旁腺体积,值得临床推广.%Objective:To investigate effects of calcitriol,cinacalcet plus comprehensive intervention on maintenance hemodialysis (MHD) patients with secondary hyperparathyroidism (SHPT) calcium (Ca),phosphorus (P) metabolism and parathyroid hormone (PTH).Methods:80 patients with SHPT that were treated in our hospital were enrolled and randomly divided into observation group and control group.Control group was assigned to eat the whole piece of cinacalcet hydrochloride oral tablets (the initial dose was 25 mg/d) for every 2 to 4 weeks.According to Ca,P,parathyroid hormone (iPTH) test results,adjust the dose,the maximum dose of was not more than 75 mg/d.Based on treatment of the control group,the observation group was given oral administration of Calcitriol Soft Capsules 0.25 g/d,3 times / week.Both groups were given comprehensive intervention measures to evaluate the curative effect after 3 months of treatment.Before and after treatment,fasting peripheral venous blood was collected to determine Ca,P and alkaline phosphatase levels by colorimetric method.Product of (Ca × P) was calculated and the level of iPTH before and after treatment was determined by ELISA method.TY-6858-HI type ultrasound instrument was applied to measure the length,width and thickness of the parathyroid glands,and calculate the parathyroid gland volume.Results:After treatment,Ca,Ca × P of patients of the observation group increased more significant than that of the control group,but Ca,P,ALP,iPTH lever decreased more significantly than that of the control group (P<0.05).The decreased size of the parathyroid gland was better than that of the control group (P<0.05).Conclusion:Calcitriol,cinacalcet combined intervention therapy has good clinical effect on patients with MHD.SHPT,Ca,P can effectively improve the metabolism,reduce the level of iPTH,reduce the parathyroid gland volume and is worthy of application in large scale.