西那卡塞治疗血液透析合并SHPT对贫血、左心室质量指数和甲状旁腺体积的影响  

Effect of cinacalcet on anemia parameters, left ventricular mass index and parathyroid volume in patients with severe SHPT in hemodialysis

作　　者：张育安 张文 吴成云 陈波 陈沛 李晓娜 Zhang Yu′an;Zhang Wen;Wu Chengyun;Chen Bo;Chen Pei;Li Xiaona(Department of Nephrology,the Third People′s Hospital of Yunnan Province,Kunming 650011,China;Department of Emergency,Yunnan Hospital of Traditional Chinese Medicine,Kunming 650021,China;Department of Neurosurgery,the Third People′s Hospital of Yunnan Province,Kunming 650011,China)

机构地区：[1]云南省第三人民医院肾病科,昆明650011 [2]云南省中医医院滇池院区急诊科,昆明650021 [3]云南省第三人民医院神经外科,昆明650011

出　　处：《国际泌尿系统杂志》2023年第3期430-435,共6页International Journal of Urology and Nephrology

基　　金：云南省教育厅科学研究基金项目(2019J0799)。

摘　　要：目的探讨西那卡塞治疗血液透析患者合并严重继发性甲状旁腺功亢进(SHPT)对贫血、左心室质量指数和甲状旁腺体积的影响。方法选取2018年1月至2019年12月在云南省第三人民医院治疗的76例合并严重SHPT的血液透析患者,记录所有患者基线时和各随访点的化验指标、甲状旁腺总体积、左心室质量指数、促红细胞生成素(EPO)和碳酸司维拉姆用量。西那卡塞治疗12个月后,按照甲状旁腺总体积变化情况分为减少组(55例)和增加组(21例),比较两组患者的临床特征。结果治疗6、12个月后,患者的血红蛋白(Hb)、红细胞压积(Hct)及网织红细胞百分比(Ret)均较基线水平明显升高(P<0.001);甲状旁腺激素(PTH)在治疗6、12个月后均明显降低(P<0.05);左心室质量指数(LVMI)治疗12个月后有所下降,但差异无统计学意义(P>0.05);成纤维细胞生长因子23(FGF23)和甲状旁腺总体积经西那卡塞治疗12个月后均显著低于基线水平(均P<0.05);EPO用量在西那卡塞治疗6个月和12个月后,用量显著降低(P<0.05);甲状旁腺总体积减少组和增加组的最终甲状旁腺总体积比较,差异有统计学意义(P<0.05)。两组患者的最终PTH均明显下降,但差异无统计学意义(P>0.05)。结论西那卡塞治疗血透患者严重SHPT,可改善贫血参数,减少EPO用量,降低甲状旁腺体积;对LVMI的改善可能获益,需要扩大样本和延长观察时间才能明确。Objective To investigate of effect of cinacalcet on anemia parameters,left ventricular mass index and parathyroid volume in patients with severe secondary hyperparathyroidism treated by hemodialysis.Methods A total of 76 maintenance hemodialysis patients with severe secondary hyperparathyroidism treated in the Third People's Hospital of Yunnan Province from January 2018 to December 2019 were selected.Laboratory parameters,total parathyroid volume(TPV),left ventricular mass index(LVMI),dosage of erythropoietin(EPO)and sevelamm carbonate were recorded at baseline and each follow-up point.After 12 months of cinacalcet treatment,the patients were divided into decreased group(55 cases)and increased group(21 cases)according to the change of total parathyroid volume.The clinical characteristics of the two groups were compared.Results After 6 and 12 months of cinacalcet treatment,hemoglobin(Hb),hematocrit(Hct)and reticulocyte percentage(Ret)were significantly higher than those at baseline(all P<0.001).Parathyroid hormone(PTH)was significantly decreased after 6 and 12 months of cinacalcet treatment(P<0.05).Left ventricular mass index(LVMI)decreased after 12 months of cinacalcet treatment,but the difference was not statistically significant(P>0.05).Fibroblast growth factor 23(FGF23)and total parathyroid volume were significantly lower than baseline levels after 12 months of cinacalcet treatment(all P<0.05).The dosage of EPO decreased significantly after 6 and 12 months of cinacalcet treatment(P<0.05).The final total parathyroid volume of the decreased parathyroid volume group and the increased parathyroid volume group were(3.72±1.02)cm3 and(6.11±0.99)cm3,respectively,and the difference was statistically significant(P<0.05).The final iPTH of the two groups decreased significantly,but the difference was not statistically significant(P>0.05).Conclusions Cinacalcet in the treatment of severe secondary hyperparathyroidism in hemodialysis patients can improve anemia parameters,reduce EPO dosage and parathyroid volume.Improveme

关 键 词：甲状旁腺功能亢进症 继发性 西那卡塞 左心室质量指数 甲状旁腺体积 贫血 

分 类 号：R582.1[医药卫生—内分泌] R692.5[医药卫生—内科学]