西那卡塞序贯活性维生素D治疗继发性甲状旁腺机能亢进症的临床效果  

Observation of the patients with secondary hyperparathyroidism taking the sequential treatment of cinacalcet and active vitamin D

作　　者：秦瑜[1] 贾凤玉[1] 刘文渊[1] 景颖[1] 荣鹏[1] 王素霞[1] Qin Yu;Jia Fengyu;Liu Wenyuan;Jing Ying;Rong Peng;WangSuxia.(Department of Blood Purification, Jinan Military District General hospital of PIA, Jinan 250031, China)

机构地区：[1]济南军区总医院血液净化科,250031

出　　处：《国际移植与血液净化杂志》2018年第2期27-29,共3页International Journal of Transplantation and Hemopurification

摘　　要：目的通过一组病例临床观察，探讨维持性血液透析合并继发性甲状旁腺机能亢进症患者使用西那卡塞、活性维生素D序贯治疗的安全性、有效性。方法我院15例维持性血液透析合并继发性甲状旁腺机能亢进症患者因高钙血症、高磷血症（Ca×P〉75mg2／dl2）、高甲状旁腺素血症使用西那卡塞治疗，其中12例甲状旁腺素（PTH）下降30％后，血钙、血磷相应较前降低（Ca×P〈65mg2／dl2），切换为活性维生素D治疗2个月。比较该12例患者活性维生素D使用前后的Ca、P、PIH、Ca×P水平。结果使用活性维生素D后2例患者因PTH升高退出观察，1例换药后2周PTH升高（1077pg／mlvs1540pg／ml），随后行甲状旁腺切除术；另一例患者于换药后1个月PTH升高（877pg／ml vs1034pg/ml），要求恢复为西那卡塞治疗。余10例（83．3％，10／12）患者甲状旁腺素继续下降到（375．3±194．9）pg/ml，（1182．92±392．30pg／ml vs 807．62±308．97gp／ml，t=2．377，P=0．029），Ca×P较前升高但低于70mg2／dl2，差异无统计学意义（49．30±3．85）mg2／dl^2 vs （52．71±3．63）md／dl^2，t=-0．643，P=0．528]，血清总Ca轻度升高[（2．17±0．13）mmol／L vs（2．35±0．18）mmol／L，t=-2．539，P=0．021]，血清P无明显改变[（1．84±0．51）mmol／L vs（1．81±0．45）mmol／L，t=0．125，P=0．902]。结论使用西那卡塞、活性维生素D序贯治疗可以继续降低甲状旁腺素，且钙磷负荷没有明显增加。Objective Safety and effectiveness were evaluted in order to investigate maintenance hemodialysis patients with secondary hyperparathyroidism taking cinacalcet, active vitamin D sequential treatment by observating a group of clinical cases. Methods In our hospital 15 maintenance hemodialysis patients with secondary hyperparathyroidism take cinacalcet due to high calcium, high phosphorus （ Ca ×P 〉 75 mg2/dl2）, and high parathyroid hormone, 12 of which parathyroid hormone （PTH） decreased by 30%, and the serum calcium or phosphorus were also decreased compared with the previous （ Ca × P 〈 65 mg2/dl2）, and now switch to the active vitamin D for 2 months. Compare the serum calcium, phosphorus, parathyroid hormone, Ca x P levels of the 12 patients brefor and after taking active vitamin D. Results After using active vitamin D, 2 patients withdrew the observation because of elevated PTH One case was found elevated PTH （ 1077 vs 1540 pg/ml） two weeks later then did the parathyroidectomy; another was found elevated PTH （877 vs 1034 pg/ml） after dressing one month, and restored cinacalcet treatment. （parathyroid hormone PTH） of the other 10 patients （83.3 %, 10/12） continued to decline （375.3 ± 194.90） g/ml, （1182.92±392.3） vs （807.62±308.97） pg/ml, t=2.377, P=0.029）, Cax Prised but be lower than the previous 70 mg2/dl2,there was no significant difference （49.30± 3.85） vs （52.71 ±3.63） mg2/dl2, t = -0.643, P = 0.528）, the serum total calcium increased slightly （2.17 ± 0.13） vs （2.35±0.18）mmol/L, t =-2.539, P = 0.021）, there was no significant change in serum phosphorus （1.84±0.51） vs （1.81±0.45）mmol/L, t=0.125, P=0.902）. Condusion Cinacalcet, active vitamin D sequential therapy may continue to reduce parathyroid hormone, calcium and phosphorus load is not significantly increase.

关 键 词：继发性甲状旁腺机能亢进症 活性维生素D 西那卡塞 序贯治疗 

分 类 号：R582.1[医药卫生—内分泌] R692.5[医药卫生—内科学]