中国血液净化

中国血液净化 ›› 2019, Vol. 18 ›› Issue (01): 8-10.doi: 10.3969/j.issn.1671-4091.2019.01.002

• 临床研究 • 上一篇    下一篇

骨化三醇联合西那卡塞治疗血液透析患者继发性甲状旁腺功能亢进的疗效

王辉1,王云2   

  1. 1. 武汉市红十字会医院血液净化科
    2. 张家港第一人民医院肾内科
  • 收稿日期:2018-05-16 修回日期:2018-09-10 出版日期:2019-01-12 发布日期:2018-12-25
  • 通讯作者: 王辉 gaoxinyin5@163.com E-mail:38864608@qq.com

Effect of calcitriol combined with cinacalcet for the treatment of secondary hyperparathyroidism in maintenance hemodialysis patients

  • Received:2018-05-16 Revised:2018-09-10 Online:2019-01-12 Published:2018-12-25

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摘要： 【摘要】目的探讨骨化三醇联合西那卡塞治疗维持性血液透析(maintenance hemodialysis, MHD)患者继发性甲状旁腺功能亢进(secondary hyperparathyroidism, SHPT)的疗效和安全性。方法选择2012 年5 月～2017 年8 月张家港第一人民医院血液透析中心接受MHD 治疗3 个月以上且继发SHPT 的患者30 例为研究对象。所有患者予以骨化三醇( 0.25 ug/d )和西那卡塞( 25～75 mg/d )治疗。治疗1、3、6 个月时，观察患者血钙、血磷、血清全段甲状旁腺激素( intact parathyroid hormone, iPTH)，计算钙磷乘积，记录不良反应发生情况。结果与治疗前比较，治疗1、3、6 个月时，患者血清iPTH 均明显降低(t=13.457，25.614，49.587，均P＜0.001)，血磷均明显降低(t=3.059，6.602，8.375，均P＜0.001)，血钙均明显升高(t=3.545，4.012，5.104，均P＜0.001)，钙磷乘积均明显降低(t=3.459, 3.897, 4.873, 均P＜0.001)。与治疗1个月时比较，治疗3、6 个月时，患者血清iPTH 均明显降低(t=19.579, 23.675, 均P＜0.001)，血磷均明显降低(t=5.309, 7.214, 均P＜0.001)，钙磷乘积均明显降低(t=3.012，4.015，均P＜0.001)；血钙治疗3、6 个月与1 个月时比较无统计学差异(t=0.905, 1.105, P=0.374, 0.301)。与治疗3 个月时比较，治疗6 个月时患者血钙差异无统计学意义(t=1.397，P=0.205)，血清iPTH 进一步降低(t=14.312，P＜0.001)。治疗过程中出现恶心呕吐4 例，腹痛2 例，肌痛1 例，经内科对症治疗后缓解，无患者因不良反应退出研究。结论骨化三醇联合西那卡塞治疗SHPT 的效果较满意，能够降低血清iPTH 水平，改善钙、磷代谢紊乱，且安全性较高。

关键词: 骨化三醇, 西那卡塞, 继发性甲状旁腺功能亢进, 血液透析

Abstract: 【Abstract】Objective To investigate the effect of calcitriol combined with cinacalcet for the treatment of secondary hyperparathyroidism (SHPT) in maintenance hemodialysis (MHD) patients. Methods Thirty patients after MHD treatment for more than three months and with SHPT in our hemodialysis center from May 2012 to August 2017 were enrolled in this study. They were treated with calcitriol (0.25 μg/d) and cinacalcet (25～75 mg/d). Serum calcium, phosphorus, calcium- phosphorus product and intact parathyroid hormone (iPTH) were assayed after the treatment for 1, 3, and 6 months. Adverse reactions due to the drugs were recorded. Results Compared the values after the treatment for 1, 3 and 6 months with those at baseline, serum iPTH, serum phosphorus and calcium and phosphorus product decreased significantly (t=13.457, 25.614 and 49.587 respectively, P＜0.001 for serum iPTH; t=3.059, 6.602 and 8.375 respectively, P＜0.001 for serum phosphorus; t=3.459, 3.897 and 4.873 respectively, P＜0.001 for calcium and phosphorus product), and
serum calcium increased significantly (t=3.545, 4.012 and 5.104 respectively, P＜0.001). Compared the values after the treatment for 3 and 6 months with those after the treatment for one month, serum iPTH, serum phosphorus and calcium and phosphorus product decreased significantly (t=19.579 and 23.675 respectively, P＜0.001 for serum iPTH; t=5.309 and 7.214 respectively, P＜0.001 for serum phosphorus; t=3.012 and 4.015 respectively, P＜0.001 for calcium and phosphorus product), but serum calcium had no significant changes (t=0.905 and 1.105 respectively, P=0.374 and 0.301 respectively). Compared the values after the treatment for 6 months with those after the treatment for 3 months, serum iPTH decreased further (t=14.312, P＜0.001), and serum calcium had no significant difference (t=1.397, P=0.205). Nausea and vomiting occurred in 5 cases, abdominal pain in one case, and myalgia in one case. These side-effects improved after reducing the dosage or changing the time of taking medicine. No termination of the treatment due to side-effects happened.
Conclusion Calcitriol combined with cinacalcet can effectively inhibit the secretion of iPTH and improve the metabolic disorders of calcium and phosphorus with minor adverse reactions. The curative effect is safe and reliable. It is worthy of clinical use.

Key words: Active vitamin D, cinacalcet, secondary hyperparathyroidism, maintenance hemodialysis