骨化三醇联合西那卡塞治疗慢性肾衰竭并继发性甲状旁腺功能亢进症的疗效  

Efficacy of calcitriol combined with cinacalcet in the treatment of chronic renal failure complicated with secondary hyperparathyroidism

作　　者：林虹 王晓松[1] LIN Hong;WANG Xiaosong(Department of Nephrology,Quanzhou First Hospital,Fujian,Fujian Province,Quanzhou 362000,China)

机构地区：[1]福建省泉州市第一医院肾内科,362000

出　　处：《临床合理用药杂志》2023年第21期18-20,24,共4页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的观察骨化三醇联合西那卡塞治疗慢性肾衰竭(CRF)并继发性甲状旁腺功能亢进症(SHPT)的疗效。方法选取福建省泉州市第一医院肾内科2019年7月—2021年11月收治的82例CRF并SHPT患者,采用随机数字表法分为西那卡塞组与联合用药组,各41例。西那卡塞组予西那卡塞治疗,联合用药组在西那卡塞组基础上予骨化三醇治疗,2组均连续治疗3个月。对比2组临床疗效、治疗前后血生化指标[钙离子、磷离子、全段甲状旁腺素(iPTH)、转化生长因子-α(TGF-α)水平及NOD样受体家族蛋白3(NLRP3)表达量]及药品不良反应(ADR)发生率。结果联合用药组总有效率明显高于西那卡塞组(97.56%vs.82.93%,χ^(2)=4.986,P=0.026)。治疗3个月后,与治疗前比较,2组钙离子浓度升高,磷离子浓度和血清iPTH、TGF-α水平及NLRP3表达量降低,且联合用药组升高/降低幅度大于西那卡塞组(P<0.01)。西那卡塞组与联合用药组ADR总发生率比较,差异无统计学意义(12.20%vs.9.76%,χ^(2)=0.114,P=0.736)。结论骨化三醇联合西那卡塞治疗CRF并SHPT的临床疗效显著,可通过有效改善TGF-α水平、NLRP3表达量而抑制病情进展,改善钙磷代谢,且安全性较高。Objective To observe the efficacy of calcitriol combined with cinacalcet in the treatment of chronic renal failure(CRF)complicated with secondary hyperparathyroidism(SHPT).Methods Eighty-two cases of CRF patients complicated with SHPT admitted to the Department of Nephrology,Quanzhou First Hospital,Fujian from July 2019 to November 2021 were selected,and they were divided into the cinacalcet group and the combination group by random number table methods,with 41 cases in each group.The cinacalcet group was treated with cinacalcet,while the combination group was treated with calcitriol based on the cinacalcet group,both groups were treated continuously for 3 months.Clinical efficacy,blood biochemical indexes(calcium ion,phosphorus ion,iPTH,TGF-αand NLRP3 expression)before and after treatment,and incidence of ADR were compared between the two groups.Results The total effective rate in the combination group was significantly higher than that in the cinacalcet group(97.56%vs.82.93%,χ^(2)=4.986,P=0.026).Compared with those before treatmment,calcium ion concentration increased and phosphorus ion concentration and serum iPTH,TGF-αlevels and NLRP3 expression decreased after 3 months of treatment in the two groups,and the increased/decreased in the combination group was greater than that in the cinacalcet group(P<0.01).There was no statistically significant difference in the overall incidence of ADR between the cinacalcet group and the combination group(12.20%vs.9.76%,χ^(2)=0.114,P=0.736).Conclusion The clinical efficacy of calcitriol combined with cinacalcet is significant in the treatment of CRF complicated with SHPT,which can inhibit the progression of disease by effectively improving the TGF-αlevel and NLRP3 expression,improve calcium and phosphorus metabolism,and with high safety.

关 键 词：慢性肾衰竭 继发性甲状旁腺功能亢进症 骨化三醇 西那卡塞 NOD样受体家族蛋白3 转化生长因子-Α 

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