中剂量骨化三醇冲击治疗血液透析患者重度甲状旁腺功能亢进的疗效分析  

Effect of moderate dose of oral calcitriol on treatment of serious secondary hyperparathyroidism in hemodialysis patients

作　　者：申伟[1] 林敏娃[1] 肖观清[1] 孔耀中[1] 

机构地区：[1]佛山市第一人民医院肾内科,广东佛山528000

出　　处：《中国现代医学杂志》2015年第1期102-105,共4页China Journal of Modern Medicine

摘　　要：目的该研究旨在观察中剂量的骨化三醇对重度继发性甲状旁腺功能亢进症的疗效。方法选择维持性血液透析患者中i PTH水平大于1 000 pg/ml的重度甲状旁腺功能亢进病人。使用中剂量骨化三醇进行冲击治疗,疗程12周,比较治疗前及治疗后患者的i PTH、血钙和磷的变化。以较基础值降低25.0%为治疗有效,降低50.0%为疗效显著,i PTH小于300 pg/ml为达标。结果共有符合条件患者44例,治疗前后血清i PTH对比,差异有统计学意义[(1 679.66±505.08)pg/ml vs(808.27±542.05)pg/ml,P<0.001]。其中38例患者血i PTH值较基础值降低超过25.0%,治疗有效率达86.4%;疗效显著者20例,占45.5%;达标者12例,占27.3%。无患者出现胃肠道不适、停服或少服药物。结论中剂量骨化三醇治疗血液透析患者重度继发性甲状旁腺功能亢进有明显的疗效,且胃肠道副作用小,患者依从性好。[ Objective] To investigate the effect of moderate dose of oral calcitriol in the treatment of serious sec- ondary hyperparathyroidism （SHPT） in hemodialysis patients. [Method] Maintenance hemodialysis patients whose intact parathyroid hormone concentrations （iPTH） was more than l 000 pg/ml were enrolled, They were given oral c, alcitriol 2μ g three times weekly for 12 weeks. Calcium and phosphate concentration, and especially the level of iPTH were detected and analyzed. The iVFH level descend more than 25.0% of base line was defined as effective, while more than 50.0% was excellent. Target iPTH was less than 300 pg/ml. [Results] Forty four subjects met the inclusion criteria. Compared with the basic iPTH level, it is signifieantly suppressed after 12 weeks of therapy [（1 679.66±505.08） pg/ml vs （808.27±542.05） pg/ml, P 〈0.001]. 12 eases （27.3%） met the target iPTH level, while 20 cases （45.5%） are excellent and 38 cases are effective. Total effective rate is 86.4%. All patients completed the study. No patient had gastrointestinal uncomfortable and no one missed medication. [Conclusions] The present study provides preliminary evidence thai moderate dose of oral ealcitriol may significantly suppress iPTH in twelve weeks on treating serious secondary, hyperparathyroidism in hemodiatysis patients. Moreover, this dose of oral cal- citril shows good compliance tot this kind of patients.

关 键 词：骨化三醇 血液透析 重度继发性甲状旁腺功能亢进症 

分 类 号：R459.5[医药卫生—治疗学] R582.1[医药卫生—临床医学]