大剂量普通维生素D和活性维生素D治疗甲状旁腺功能减退症有效性和安全性的比较  

Comparison of effectiveness and safety of high-dose native vitamin D versus active vitamin D in the treatment of hypoparathyroidism

作　　者：陈思行 王亚冰 王鸥 聂敏 姜艳 李梅 夏维波 邢小平 Chen Sixing;Wang Yabing;Wang Ou;Nie Min;Jiang Yan;Li Mei;Xia Weibo;Xing Xiaoping(Department of Endocrinology,Key Laboratory of Endocrinology,Ministry of Health,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院内分泌科,国家卫生和计划生育委员会内分泌重点实验室,100730

出　　处：《中华内分泌代谢杂志》2019年第10期859-863,共5页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的回顾性分析非手术性甲状旁腺功能减退症(non-surgical hypoparathyroidism,ns-HP)患者的临床资料,探索比较使用大剂量普通维生素D或者(和)活性维生素D治疗的安全性和有效性。方法纳入3年内治疗方案较为稳定的ns-HP患者,根据不同维生素D治疗方案分为普通维生素D组、活性维生素D组和混合维生素D组。通过分析治疗后血钙水平、低钙血症相关症状及体征、有临床意义低钙血症的发生情况,比较不同维生素D治疗方案的有效性。通过分析随访过程中各组患者高钙血症和高尿钙发生情况、是否使用噻嗪类利尿剂、是否出现肾钙化或泌尿系结石、以及eGFR评估安全性。结果活性维生素D组发生低钙血症频率高于普通维生素D组(32.94%±21.46%对24.86%±10.1%,P<0.05),其余评估的有效性和安全性指标在3组之间差异均无统计学意义(P>0.05)。结论在规律治疗和监测下,使用大剂量普通维生素D或者活性维生素D均能安全有效地治疗甲状旁腺功能减退症,在稳定血钙水平、减少低钙血症发作方面普通维生素D可能优于活性维生素D。Objective To investigate the effectiveness and safety of high-dose native vitamin D versus active vitamin D by retrospective analysis of clinical data in patients with non-surgical hypoparathyroidism(ns-HP)in our hospital.Methods ns-HP patients with stable therapeutic schedule in recent three years were included.According to the vitamin D agents used,patients were divided into three groups:active vitamin D group,native vitamin D group,and mixed vitamin D group.The effectiveness was evaluated by analysis of markers including post-treatment serum calcium,incidence of hypocalcemia,hypocalcemic symptoms and signs.The safety was evaluated in various groups by analyzing incidences of hypercalcemia and hypercalciuria,glomerular filtration rate,percentage of thiazide diuretic use,nephrocalcinosis or renal stone.Results Patients in active vitamin D group were more likely to experience episodes of hypocalcemia compared with those in native group(32.94%±21.46%vs 24.86%±10.1%,P<0.05).No significant differences in other indexes for assessing effectiveness and safety were found among three groups(P>0.05).Conclusions Under the circumstance of regular follow-up,both high-dose native vitamin D and active vitamin D could treat ns-HP effectively and safely.Native vitamin D may be better in maintaining eucalcemia and reducing incidence of hypocalcemia compared with active vitamin D.

关 键 词：非手术性甲状旁腺功能减退症 普通维生素D 活性维生素D 治疗 

分 类 号：R73[医药卫生—肿瘤]