不同剂量帕立骨化醇联合西那卡塞治疗维持性血液透析患者继发性甲状旁腺功能亢进的临床研究  

Clinical study on different doses of paricalcitol combined with cinacalcet in the treatment of secondary hyperparathyroidism in patients with maintenance hemodialysis

作　　者：薛宇[1] 韦丽 王婷婷[1] 李亚伟[1] 刘翠萍[1] Xue Yu;Wei Li;Wang Tingting;Li Yawei;Liu Cuiping(Department of Nephrology,Beijing Geriatric Hospital,Beijing 100095,China)

机构地区：[1]北京老年医院肾内科,北京100095

出　　处：《中国医师进修杂志》2023年第11期983-989,共7页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探究不同剂量帕立骨化醇联合西那卡塞治疗维持性血液透析(MHD)合并继发性甲状旁腺功能亢进(SHPT)患者的疗效。方法回顾性分析北京老年医院2020年12月至2022年12月90例MHD合并SHPT患者的临床资料。其中,采用西那卡塞治疗30例(对照组),采用固定剂量帕立骨化醇联合西那卡塞治疗30例(试验A组),采用依据全段甲状旁腺激素(iPTH)水平调整帕立骨化醇剂量联合西那卡塞治疗30例(试验B组),均连续治疗8周。分别于治疗前和治疗4、8周后检测血钙、血磷、iPTH、骨保护素、骨钙素、Ⅰ型胶原羧基端肽交联(β-CTX)、钙素N端中分子片段(N-MID)、成纤维细胞生长因子-23(FGF-23)和Klotho蛋白,同时行冠状动脉钙化(CAC)评分和腹主动脉钙化(AAC)评分;记录不良反应。结果三组治疗前各指标比较差异有统计学意义(P<0.05)。三组治疗4和8后血钙和血磷比较差异无统计学意义(P>0.05)。治疗4和8周后,试验A组和试验B组iPTH、β-CTX、骨保护素、N-MID、骨钙素和FGF-23明显低于对照组[治疗4周后:(936.99±202.36)和(635.74±135.44)ng/L比(1028.56±11.39)ng/L、(1.85±0.32)和(1.50±0.27)μg/L比(2.27±0.69)μg/L、(71.18±6.98)和(64.33±7.87)ng/L比(80.15±10.85)ng/L、(106.36±14.42)和(92.64±11.32)μg/L比(135.19±15.18)μg/L、(66.17±8.52)和(60.21±7.85)μg/L比(73.15±9.44)μg/L、(109.17±11.24)和(98.50±10.36)ng/L比(126.18±15.64)ng/L;治疗8周后:(632.17±154.98)和(526.85±98.45)ng/L比(819.85±169.78)ng/L、(1.33±0.15)和(1.15±0.20)μg/L比(1.78±0.27)μg/L、(65.78±9.74)和(52.77±7.18)ng/L比(74.26±11.58)ng/L、(85.64±11.62)和(70.25±8.59)μg/L比(105.92±19.17)μg/L、(48.17±5.99)和(41.15±6.44)μg/L比(59.24±6.87)μg/L、(90.15±11.25)和(82.58±9.74)ng/L比(105.26±14.35)ng/L],试验B组明显低于试验A组,差异有统计学意义(P<0.05);试验A组和试验B组Klotho蛋白明显高于对照组[治疗4周后:(124.25±14.85)和(146.31±16.85)U/L比(107.26±11.36)U/L;治疗8�Objective To investigate the clinical value of different doses of paricalcitol combined with cinacalcet in the treatment of secondary hyperparathyroidism(SHPT)in patients with maintenance hemodialysis(MHD).Methods The clinical data of 90 patients with MHD combined with SHPT from December 2020 to December 2022 in Beijing Geriatric Hospital were retrospectively analyzed.Among them,30 patients were treated with cinacalcet(control group),30 patients were treated with fixed dose paricalcitol combined with cinacalcet(experimental group A),and 30 patients were treated with adjusting dose of paricalcitol based on the level of intact parathyroid hormone(iPTH)combined with cinacalcet(experimental group B).All patients were continuously treated for 8 weeks.The blood calcium,blood phosphorus,iPTH,osteoprotegerin,osteocalcin,typeⅠcollagen carboxy terminal peptide cross-linking(β-CTX),N-terminal medium molecule fragment of calcium(N-MID),fibroblast growth factor-23(FGF-23)and Klotho protein before treatment and after 4 and 8 weeks of treatment were detected;coronary artery calcification(CAC)score and abdominal aortic calcification(AAC)score were evaluated.The adverse reactions were recorded.Results There were no statistical differences in the indexes before treatment among three groups(P>0.05).There were no statistical differences in blood calcium and blood phosphorus after 4 and 8 weeks of treatment among three groups(P>0.05).After 4 and 8 weeks of treatment,the iPTH,β-CTX,osteoprotegerin,N-MID,osteocalcin and FGF-23 in experimental group A and experimental group B were significantly lower than those in control group,after 4 weeks of treatment:(936.99±202.36)and(635.74±135.44)ng/L vs.(1028.56±11.39)ng/L,(1.85±0.32)and(1.50±0.27)μg/L vs.(2.27±0.69)μg/L,(71.18±6.98)and(64.33±7.87)ng/L vs.(80.15±10.85)ng/L,(106.36±14.42)and(92.64±11.32)μg/L vs.(135.19±15.18)μg/L,(66.17±8.52)and(60.21±7.85)μg/L vs.(73.15±9.44)μg/L,(109.17±11.24)and(98.50±10.36)ng/L vs.(126.18±15.64)ng/L;after 8 weeks of treatment:(632.

关 键 词：甲状旁腺功能亢进症 继发性 肾透析 帕立骨化醇 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]