西那卡塞联合骨化三醇延缓尿毒症继发性甲状旁腺功能亢进患者血管钙化的疗效  

Effect of cinacalcet combined with calcitriol in retarding the course of vascular calcification of uremia patients with secondary hyperparathyroidism

作　　者：亢宁苏 崔俊[1] 郑露[1] 陆建勋[1] 周春霞[1] KANG Ningsu;CUI Jun;ZHENG Lu;LU Jianxun;ZHOU Chunxia(Department of Nephrology,Nantong Third People′s Hospital,Nantong 226000,China)

机构地区：[1]南通市第三人民医院肾内科,南通226000

出　　处：《西北药学杂志》2021年第2期304-309,共6页Northwest Pharmaceutical Journal

摘　　要：目的探讨西那卡塞联合骨化三醇对尿毒症继发性甲状旁腺功能亢进(SHPT)患者血管钙化的影响及作用机制。方法选取尿毒症SHPT患者70例,按照随机数字表法均分为观察组与对照组。对照组接受常规内科治疗和骨化三醇冲击治疗,观察组在对照组治疗的基础上联用西那卡塞治疗。随访6个月,测定患者的血钙、血磷、钙磷乘积、血清全段甲状旁腺激素(iPTH)、血清成纤维细胞生长因子23(FGF23)、klotho蛋白、胎球蛋白(fetuin-A)、超敏C反应蛋白(hs-CRP)和白细胞介素-6(IL-6)水平,评价颈动脉斑块(Grouse)评分、冠状动脉钙化(CAC)评分和腹主动脉钙化(AAC)积分。结果治疗3、6个月后观察组的血钙、血磷、钙磷乘积和iPTH均低于对照组(P<0.05);观察组的症状改善率为62.86%,明显高于对照组的5.71%(P<0.05)。治疗3、6个月后,观察组血清klotho蛋白和fetuin-A显著高于对照组,血清FGF23、hs-CRP和IL-6水平均显著低于对照组(P<0.05);治疗6个月后,观察组的Grouse、CAC和AAC评分均显著低于对照组(P<0.05);随访6个月,观察组的颈动脉、冠状动脉及腹主动脉钙化率均显著低于对照组(P<0.05)。结论西那卡塞联用骨化三醇冲击治疗尿毒症SHPT的疗效优于单药治疗,且可延缓血管钙化进程,其机制可能与上调血清klotho蛋白和fetuin-A表达、下调FGF23和炎症因子表达有关。Objective To investigate the effect of cinacalcet combined with calcitriol on vascular calcification of uremia patients with secondary hyperparathyroidism(SHPT)and its mechanisms.Methods 70 uremia patients with refractory SHPT were divided into observation group and control group according to treatment methods.The control group received conventional medical treatment and calcitriol pulse therapy,while the observation group received cinacalcet on the basis of the control group.Follow-up for 6 months,the blood calcium,blood phosphorus,calcium-phosphorus product,intactparathy-roid parathyroid hormone(iPTH),serum fibroblast growth factor 23(FGF23),klotho protein,fetuin-A,hypersensitive C-reactive protein(hs-CRP)and interleukin-6(IL-6)were determined,and the carotid plaque(Grouse)score,coronary artery calcification(CAC)score and abdominal aorta calcification(AAC)score were evaluated.Results After 3 and 6 months of treatment,the blood calcium,blood phosphorus,calcium-phosphorus product and iPTH of the observation group were lower than those of the control group(P<0.05);the symptom improvement rate of the observation group was 62.86%,which was significantly higher than 5.71%of the control group(P<0.05).At 3 and 6 months after treatment,the serum levels of klotho protein and fetuin-A in observation group were significantly higher than in control group,while the levels of FGF23,hs-CRP and IL-6 were significantly lower than in the control group(P<0.05).At 6 months after treatment,the Grouse,CAC and AAC scores in observation group were significantly lower than in the control group(P<0.05).After 6 months of follow-up,the calcification rates of carotid,coronary and abdominal aorta in the observation group were significantly lower than those in the control group(P<0.05).Conclusion Cinacalcet combined with calcitriol is more effective than monotherapy in the treatment of SHPT,which can delay the process of vascular calcification.The mechanism may be related to the up-regulation of serum klotho protein and fetuin-A expression,an

关 键 词：继发性甲状旁腺功能亢进 尿毒症 西那卡塞 骨化三醇 血管钙化 

分 类 号：R983[医药卫生—药品]