帕立骨化醇联合西那卡塞治疗血液透析伴继发性甲状旁腺功能亢进的效果研究  

The effect of paricalcitol combined with cinacalcet in the treatment of hemodialysis patients with secondary hyperparathyroidism

作　　者：王富菊 陈文君[1] 孙强[1] 薛丽莉[1] 郁丽霞[1] Wang Fuju;Chen Wenjun;Sun Qiang;Xue Lili;Yu Lixia(Department of Nephrology,Kunshan Affiliated Hospital of Jiangsu University,Kunshan 215300,China)

机构地区：[1]江苏大学附属昆山医院肾内科,昆山215300

出　　处：《国际泌尿系统杂志》2022年第1期82-86,共5页International Journal of Urology and Nephrology

摘　　要：目的研究帕立骨化醇联合西那卡塞治疗维持性血液透析(MHD)继发性甲状旁腺功能亢进(SHPT)患者的疗效和安全性。方法选取2019年8月至2020年8月本院血液净化中心收治的22例MHD伴SHPT患者为研究对象,所有患者根据全段甲状旁腺激素(iPTH)水平予以帕立骨化醇联合西那卡塞治疗。分别于治疗前及治疗后2、4、8、12周测定患者的血钙、血磷、iPTH,计算钙磷乘积,比较这些指标的变化;观察患者治疗12周前后的骨代谢四项(β胶原特殊序列、N端骨钙素、总Ⅰ型胶原氨基延长肽、25羟维生素D)水平的变化;记录研究过程中患者的不良反应发生情况。结果与治疗前相比,治疗后第2、4、8、12周患者的iPTH水平明显降低,差异均有统计学意义(t=5.337、4.818、4.818、6.340,均P<0.01)。治疗后患者的血清钙、磷、钙磷乘积水平与治疗前相比,差异均无统计学意义(P>0.05)。治疗12周后患者的β胶原特殊序列水平由治疗前的(4.33±1.73)ng/mL降至(3.23±1.52)ng/mL,N端骨钙素由(192.95±48.22)ng/mL上升至(221.09±48.84)ng/mL、25羟维生素D由(17.77±8.01)ng/mL上升至(21.00±10.30)ng/mL,差异均有统计学意义(均P=0.02),总Ⅰ型胶原氨基延长肽水平由(800.32±364.97)ng/mL降至(725.50±377.63)ng/mL,但差异无统计学意义(P>0.05)。治疗过程中,出现胃肠道反应6例,经调整药量后可好转;发生高钙血症者有5例,经调整药物用量后血钙水平得到控制。结论帕立骨化醇联合西那卡塞治疗MHD继发SHPT的效果较好,可有效降低血清iPTH水平,减少高钙血症的发生,改善骨代谢,且不良反应较少,具有良好的安全性。Objective To investigate the efficacy and safety of paricalcitol combined with cinacalcet in treatment of maintenance hemodialysis(MHD)patients with secondary hyperparathyroidism(SHPT).Methods A total of 22 patients with SHPT in maintenance hemodialysis were enrolled in this study from August 2019 to August 2020.All patients were treated with paricalcitol and cinacalcet based on the level of intact parathyroid hormone(iPTH).Serum levels of calcium,phosphorus,and iPTH were measured before and 2,4,8 and 12 weeks after treatment.The product of calcium and phosphorus was calculated and the changes of these indexes were compared.The changes of four bone metabolism items(βcollagen special sequence,N terminal osteocalcin,total typeⅠcollagen aminopeptide,25 hydroxyvitamin D)were observed after 12 weeks of treatment.The incidence of adverse reactions in patients during the study was recorded.Results Compared with before treatment,iPTH level of patients at 2,4,8 and 12 weeks after treatment was significantly decreased,with statistical significance(t=5.337,4.818,4.818,6.340,P<0.001).There was no statistical significance in serum calcium,phosphorus and calcium-phosphorus product levels after treatment compared with before treatment(P>0.05).After 12 weeks of treatment,the level ofβcollagen special sequence decreased from(4.33±1.73)ng/mL to(3.23±1.52)ng/mL,the difference was statistically significant(t=3.531,P=0.02).Nterminal osteocalcin increased from(192.95±48.22)ng/mL to(221.09±48.84)ng/mL,25 hydroxyvitamin D increased from(17.77±8.01)ng/mL to(21.00±10.30)ng/mL,the differences were statistically significant(all P=0.02),the level of total typeⅠcollagen aminoprolonging peptide decreased from(800.32±364.97)ng/mL to(725.50±377.63)ng/mL,but the difference was not statistically significant(P>0.05).In the course of treatment,6 cases had gastrointestinal reaction,which could be improved after adjusting dosage.There were 5 cases of hypercalcemia,and the blood calcium level was controlled by adjusting the dosage of pari

关 键 词：肾透析 甲状旁腺功能亢进症 继发性 帕立骨化醇 盐酸西那卡塞 

分 类 号：R692.5[医药卫生—泌尿科学] R582.1[医药卫生—外科学]