碳酸镧联合西那卡塞、骨化三醇对血液透析伴继发性甲状旁腺功能亢进症的疗效  

Curative effect of lanthanum carbonate combined with cinacalcet and calcitriol on SHPT patients undergo⁃ing hemodialysis

作　　者：徐骏[1] 王笑薇[1] 刘旻[1] 齐向明[2] XU Jun;WANG Xiaowei;LIU Min;QI Xiangming(Blood Purification Center,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;不详)

机构地区：[1]安徽医科大学第一附属医院血液净化中心,合肥230022 [2]安徽医科大学第一附属医院肾脏内科,合肥230022

出　　处：《实用医学杂志》2021年第1期82-86,共5页The Journal of Practical Medicine

基　　金：2019年度安徽省自然科学基金项目(编号:1908085MH245)。

摘　　要：目的探讨碳酸镧联合西那卡塞、骨化三醇对维持性血液透析伴继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)患者甲状腺激素、磷钙代谢及临床症状的影响。方法回顾性分析本院门诊2017年1月至2020年4月90例维持性血液透析伴SHPT患者临床资料,依照给药方式,将采用单纯骨化三醇治疗的患者16例纳入C组,采用西那卡塞联合骨化三醇治疗的患者36例纳入B组,采用碳酸镧联合骨化三醇、西那卡塞治疗的患者38例纳入A组,比较三组患者临床症状、血清全段甲状旁腺激素(iPHT)水平、磷钙代谢水平、不良反应发生情况。结果A组治疗后1、3、6个月血清iPHT水平低于B组,B组低于C组(P<0.05);A组、B组治疗后6个月iPTH达标率分别为94.74%、83.33%,高于C组56.25%(P<0.05);三组患者治疗后皮肤瘙痒、骨关节疼痛症状均较治疗前改善(P<0.05);三组患者治疗后皮肤瘙痒、骨关节疼痛比例比较差异无统计学意义(P>0.05);A组、B组治疗后1、3、6个月血钙、血磷、钙磷乘积低于C组,A组血磷、钙磷乘积低于B组(P<0.05);三组患者治疗期间不良反应发生率比较(P>0.05)。结论碳酸镧联合西那卡塞、骨化三醇可有效改善维持性血液透析伴SHPT患者临床症状,降低iPHT激素水平,改善钙磷代谢,用药安全性较高。Objective To explore the effects of lanthanum carbonate combined with cinacalcet and calcitriol on thyroid hormone,phosphorus⁃calcium metabolism and clinical symptoms in hyperparathyroidism patients undergoing maintenance hemodialysis(MHD).Methods The clinical data of 90 patients with secondary hyperparathyroidism(SHPT)who underwent MHD in outpatient of the hospital from January 2017 to April 2020 were retrospectively analyzed.According to different administration methods,the 16 patients who were treated with calcitriol were included in group C,36 patients who treated with cinacalcet and calcitriol were included in group B,and 38 patients who treated with lanthanum carbonate combined with calcitriol and cinacalcet were included in group A.The clinical symptoms,levels of serum intact parathyroid hormone(iPHT)and phosphorus⁃calcium metabolism,and occurrence of adverse reactions were compared among the three groups.Results At 1 month,3 months and 6 months after treatment,level of serum iPHT was the highest in group C,followed by group B and group A(P<0.05).At 6 months after treatment,controls rates of iPTH in groups A and B were 94.74%and 83.33%,which were higher than that in group C(56.25%)(P<0.05).After treatment,skin itching and bone joint pain in the three groups were improved(P<0.05).There was no significant difference in the proportion of patients with skin itching and bone joint pain among the three groups(P>0.05).At 1 month,3 months and 6 months after treatment,serum calcium,serum phosphorus and calcium phosphorus product in group A and B were lower than those in group C.The serum phosphorus and calcium phosphorus product in group A were lower than those in group B(P<0.05).There was no significant difference in the incidence of adverse reactions during treat⁃ment among the three groups(P>0.05).Conclusion Lanthanum carbonate combined with cinacalcet and cal⁃citriol can effectively improve clinical symptoms of SHPT patients undergoing MHD,reduce iPHT level,and im⁃prove calcium⁃phosphorus metabolism

关 键 词：维持性血液透析 甲状旁腺功能亢进 西那卡塞 骨化三醇 碳酸镧 甲状旁腺激素 

分 类 号：R692[医药卫生—泌尿科学]