中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (03): 158-161.doi: 10.3969/j.issn.1671-4091.2017.03.004

• 临床研究 • 上一篇    下一篇

西那卡塞联合小剂量骨化三醇对持续非卧床腹膜透析患者难治性继发性甲状旁腺功能亢进疗效观察研究

金磊1,贾顺莲1,高新英1,马志宏1,王玉英1   

  1. 青海省西宁市第一人民医院肾内科
  • 收稿日期:2016-08-19 修回日期:2016-11-29 出版日期:2017-03-12 发布日期:2017-03-12
  • 通讯作者: 金磊 qhjinlei@126.com E-mail:qhjinlei@126.com

Observational research of cinacalcet combined with small dose of calcitriol for the treatment of refractory secondary hyperparathyroidism in continuous ambulatory peritoneal dialysis patients

  • Received:2016-08-19 Revised:2016-11-29 Online:2017-03-12 Published:2017-03-12

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摘要： 目的研究西那卡塞联合小剂量骨化三醇对持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis，CAPD)患者难治性继发性甲状旁腺功能亢进(secondary hyperparathyroidism, SHPT)疗效。方法选取2015 年5 月～2016 年1 月CAPD 伴SHPT 经骨化三醇冲击治疗无效16 例患者，行西那卡塞联合小剂量骨化三醇治疗，收集患者治疗前、后血清、尿标本及甲状旁腺超声检查。采用放射免疫法测定全段甲状旁腺激素(intact parathyroid hormone，iPTH)，全自动日立化学分析仪检测血钙(serum calcium,SCa)、血磷(serum phosphorus,SP)、碱性磷酸酶(alkaline phosphatase,ALP)、白蛋白(albumin,ALB)等指标。结果西那卡塞联合小剂量骨化三醇治疗后iPTH、SCa、SP、Ca×P 较治疗前比较明显下降,iPTH(F =13.152,P＜0.001); SCa(F= 4.602,P=0.002)；SP(F =8.723,P＜0.001];Ca×P(F=8.683,P＜0.001]，差异均具有统计学意义。血红蛋白(hemoglobin,Hb)及ALB(albumin)无明显差异，Hb(F=0.744,P=0.565]；ALB(F=0.624,P=0.647]，均无统计学意义。12 例甲状旁腺增生患者中8 例甲状旁腺体积减小；有临床症状的13 例患者中11 例缓解，1 例减轻，1 例转至外院行甲状旁腺切除术。结论西那卡塞联合小剂量骨化三醇治疗维持性腹膜透析继发难治性SHPT 疗效肯定、无创、风险小、使很多患者免除了甲状旁腺切除手术风险，在临床治疗继发性甲状旁腺功能亢进方面值得推广。

关键词: 西那卡塞, 小剂量骨化三醇, 持续非卧床腹膜透析, 难治性继发性甲状旁腺功能亢进, 疗效观察

Abstract: Objective To study the effect of cinacalcet combined with small dose of calcitriol for the treatment of refractory secondary hyperparathyroidism (SHPT) in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods We recruited 16 CAPD patients with SHPT refractory to short period of large dose of calcitriol during the period from May 2015 to Jan. 2016. We then observed the effect of cinacalcet combined with small dose of calcitriol in these patients. Serum and urine samples were collected, parathyroid ultrasonography was examined, and serum Ca, P, ALP, iPTH and albumin were assayed before and after the
therapy. Results After the therapy of cinacalcet combined with small dose of calcitriol, serum iPTH, Ca, P, and CaxP product decreased significantly, as compared with those before the treatment (iPTH: 257.84±99.82 pg/ml, F=13.152, P<0.01; Ca: 2.22±0.11 mmol/L, F=4.602, P<0.05; P: 1.28±0.37 mmol/L, F= 8.723, P<0.01; CaxP product: 34.69±9.54 mmol2/L2, F=8.683, P<0.01); hemoglobin and albumin changed insignificantly (Hb: 112.81±10.80 g/L, F=0.744, P＞0.05; albumin: 37.34±4.98 g/L, F=0.624, P＞0.05). After the therapy, the size of parathyroid decreased in 8 of the 12 patients with parathyroid hyperplasia; in 13 symptomatic patients, clinical symptoms alleviated in 11 patients and relieved in one patient, and parathyroidectomy was conducted in one patient. Conclusion Cinacalcet combined with small dose of calcitriol is effective, noninvasive and low risk for the treatment of CAPD patients with refractory SHPT. Parathyroidectomy may not be necessary in some patients using this therapy. We recommend this therapy as the primary management for CAPD patients with refractory SHPT.

Key words: Cinacalcet, Small dose of calcitriol, Continuous ambulatory peritoneal dialysis, Refractory secondary hyperparathyroidism, Clinical observation