骨化三醇口服或静脉给药联合西那卡塞治疗维持性血液透析患者继发性甲状旁腺功能亢进症的疗效观察  

Oral or intravenous calcitriol combined with cinacalcet in the treatment of secondary hyperparathyroidism in maintenance hemodialysis patients

作　　者：于茜[1] 朱晗玉[1] 龙玲玲[1] 王芳[1] 赵小淋 YU Qian;ZHU Hanyu;LONG Lingling;WANG Fang;ZHAO Xiaolin(Department of Nephrology,Chinese PLA General Hospital,Chinese PLA Institute of Nephrology,State Key Laboratory of Kidney Diseases,National Clinical Research Center for Kidney Diseases,Beijing Key Laboratory of Kidney Diseases,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心肾脏病科,解放军肾脏病研究所,肾脏疾病国家重点实验室,国家慢性肾病临床医学研究中心,肾脏疾病研究北京市重点实验室,北京100853

出　　处：《中华实用诊断与治疗杂志》2020年第7期678-682,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(61971441);国家自然科学基金(61671479)。

摘　　要：目的比较尿毒症维持性血液透析患者继发性甲状旁腺功能亢进症(secondary hyperparathyroidism, SHPT)口服或静脉注射骨化三醇联合西那卡塞治疗的效果及安全性。方法维持性血液透析3个月以上SHPT患者50例,根据血清甲状旁腺激素(parathormone, PTH)水平分为轻度组(PTH 300~600 ng/L)29例和中重度组(PTH>600 ng/L)21例;再根据骨化三醇给药方式,轻度组分为口服亚组16例、静脉亚组13例,中重度组分为口服亚组12例、静脉亚组9例。轻、中重度组均给予盐酸西那卡塞餐中吞服,初始剂量均为25 mg/d;轻、中重度组口服及静脉亚组骨化三醇初始剂量分别为1~2μg/次、2~4μg/次,均2次/周;之后各组根据血钙和患者耐受情况调整西那卡塞、骨化三醇剂量,每2~4周调整1次,西那卡塞最大剂量为100 mg/d,骨化三醇最大剂量为6μg/d。分别于治疗前及治疗3、6个月采集透析前空腹静脉血,检测血钙、血磷、PTH、碱性磷酸酶(alkaline phosphatase, ALP)水平;记录西那卡塞、骨化三醇使用剂量;比较治疗期间不良反应发生率。结果轻度组口服、静脉亚组治疗前及治疗3、6个月血清PTH水平在组间比较差异有统计学意义(P<0.05),静脉亚组治疗后3个月血磷水平[(2.97±0.57)mmol/L]较治疗前[(2.71±0.49)mmol/L]增高(P<0.05),且高于口服亚组[(2.02±0.39)mmol/L](P<0.05),治疗后6个月血清PTH水平[(128.93±61.23)ng/L]较口服组[(244.74±39.31)ng/L]降低(P<0.05)。中重度组口服、静脉亚组治疗前及治疗3、6个月血清PTH、ALP水平在组间比较差异有统计学意义(P<0.05);静脉亚组治疗3、6个月血清PTH水平[(386.67±89.84)、(177.88±68.63)ng/L]较治疗前[(868.45±189.66)ng/L]降低,治疗6个月ALP水平[(66.25±27.39)u/L]较治疗前[(151.58±85.11)u/L]、治疗3个月[(109.90±49.92) u/L]降低(P<0.05),且治疗6个月血清PTH水平较口服亚组[(300.23±63.01)ng/L]明显降低(P<0.05);口服亚组治疗6个月PTH水平较治疗前[(654.00±96Objective To compare the efficacy and safety of oral and intravenous calcitriol combined with cinacalcet in the treatment of secondary hyperparathyroidism(SHPT)in maintenance hemodialysis patients.Methods Fifty patients with SHPT undergoing maintenance hemodialysis for more than 3 months were divided into 29 patients with parathyroid hormone(PTH)of 300 to 600 ng/L(mild group)and 21 patients with PTH≥600 ng/L(moderate/severe group).Mild group was redivided into 16 patients receiving oral calcitriol(mild oral subgroup)and 13 patients receiving intravenous calcitriol(mild intravenous subgroup).Moderate/severe group was redivided into 12 patients receiving oral calcitriol(moderate/severe oral subgroup)and 9 patients receiving intravenous calcitriol(moderate/severe intravenous subgroup).Cinacalcet was given with meals at an initial dose of 25 mg/d,while calcitriol was initially given 1 to 2μg each time in mild group and 2 to 4μg each time in moderate/severe group,twice per 2 week.The doses of cinacalcet and calcitriol were adjusted once every 2 to 4 weeks according to the serum calcium level and the patient’s tolerance,with the maximum cinacalcet and calcitriol doses of 100 mg/d and 6μg/d.The fasting levels of serum calcium,phosphorus,PTH and alkaline phosphatase were detected before treatment,and after 3-and 6-month treatment.The doses of cinacalcet and calcitriol were recorded.The incidence of adverse reactions during treatment was compared.Results The PTH level showed a significant difference between mild oral and intravenous subgroups before treatment and after 3-and 6-month treatment(P<0.05).The blood phosphorus level was higher after 3-month treatment((2.97±0.57)mmol/L)than that before treatment((2.71±0.49)mmol/L)in mild intravenous subgroup,higher than that in mild oral subgroup((2.02±0.39)mmol/L)(P<0.05).The PTH level was lower after 6-month treatment in mild intravenous subgroup((128.93±61.23)ng/L)than that in mild oral subgroup((244.74±39.31)ng/L)(P<0.05).The levels of PTH and alkaline phosphatas

关 键 词：继发性甲状旁腺功能亢进 血液透析 西那卡塞 骨化三醇 

分 类 号：R692.5[医药卫生—泌尿科学]