低剂量西那卡塞联合骨化三醇注射液治疗血液透析患者难治性继发性甲状旁腺功能亢进症的效果观察  

Observation of low dosage of cinacalcet combined with calcitriol injection for the treatment of refractory secondary hyperparathyroidism in hemodialysis patients

作　　者：郭军利 黎思嘉 文枫[2] 王利平[2] 符霞[2] 马建超[2] 李卓[2] 冯仲林[2] 刘双信[2] 孙孟颖 GUO Jun-li;SUN Meng-ying;LI Si-jia;WEN Feng;WANG Li-ping;FU Xia;MA Jian-chao;LI Zhuo;FENG Zhong-lin;LIU Shuang-xin(Department of Nephrology,Zhuhai People's Hospital,Zhuhai 519000,China)

机构地区：[1]珠海市人民医院(暨南大学附属珠海医院)肾内科,珠海519000 [2]广东省人民医院血液净化中心,广州510030

出　　处：《临床肾脏病杂志》2020年第11期873-877,共5页Journal Of Clinical Nephrology

摘　　要：目的观察低剂量西那卡塞联合骨化三醇注射液治疗维持性血液透析(maintenance hemodialysis,MHD)患者难治性继发性甲状旁腺功能亢进症(refractory secondary hyperparathyroidism,SHPT)的效果。方法对2018年8月至2019年7月广东省人民医院血液净化中心行MHD伴SHPT、既往曾口服低剂量西那卡塞联合骨化三醇无效、且不能耐受西那卡塞增加剂量的患者进行回顾性分析,其中观察组18例,给予口服低剂量西那卡塞联合骨化三醇注射液间断脉冲式治疗,对照组16例,给予骨化三醇注射液间断脉冲式治疗。测定两组治疗前、治疗1个月及治疗3个月的血清PTH水平,分析治疗前后PTH等指标的变化及其意义。结果观察组基线、治疗1个月、治疗3个月PTH分别为(884.63±260.26)pg/mL、(685.40±329.36)pg/mL、(506.48±394.95)pg/mL,治疗1个月及3个月PTH均降低,P<0.05,差异有统计学意义;对照组基线、治疗1个月、治疗3个月PTH分别为(888.40±257.27)pg/mL、(812.36±296.51)pg/mL、(700.62±335.58)pg/mL,治疗1个月及3个月PTH虽有降低,但差异无统计学意义。结论低剂量西那卡塞联合骨化三醇注射液较单用骨化三醇注射液治疗难治性SHPT效果更好,可以作为治疗难治性SHPT的备选方案之一。Objective To observe the effect of the combination of low dosage of cinacalcet with calcitriol injection on refractory secondary hyperparathyroidism(SHPT)in maintenance hemodialysis(MHD)patients.Methods A total of 34 maintenance hemodialysis(MHD)patients with refractory SHPT,undergoing MHD in the dialysis center of Guangdong Provincial People's Hospital from August 2018 to July 2019,were recruited.These patients had a history of failure to low oral dosage of cinacalcethydrochloride combined with calcitriol,and could not tolerate increased dosage of cinacalcet.They were analyzed retrospectively.Eighteen refractory SHPT patients received treatment of cinacalcet combined with intermittent pulse injection of calcitriol as observation group,and sixteen refractory SHPT patients received treatment of calcitriol injection as control group.Serum PTH levels were measured before treatment and one month and three months after treatment.The change of PTH and biochemical index before and after treatment were analyzed.Results The PTH levels before treatment and one month and three months after treatment in the observation group were(884.63±260.26)pg/mL,(685.40±329.36)pg/mL and(506.48±394.95)pg/mL,respectively.Compared to the baseline,the PTH levels one month and three months after treatment in the observation group were decreased,with statistically significant difference(P<0.05).The PTH levels before treatment and one month and three months after treatment in the control group were(888.40±257.27)pg/mL,(812.36±296.51)pg/mL and(700.62±335.58)pg/mL,respectively.Though the PTH levels one month and three months after treatment were decreased compared to the baseline,the difference had no statistical significance.Conclusions Low dosage of cinacalcet combined with intermittent pulse injection of calcitriol have higher effect on refractory SHPT in maintenance hemodialysis patients,and so can be used as an option for refractory SHPT.

关 键 词：西那卡塞 骨化三醇注射液 甲状旁腺功能亢症 继发性 血液透析 

分 类 号：R692.5[医药卫生—泌尿科学]