帕立骨化醇联合碳酸镧治疗慢性肾脏病矿物质与骨代谢异常维持性血液透析患者的效果  

Clinical efficacy of paricalcitol combined with lanthanum carbonate in treatment of mineral and bone metabolism disorder in patients with chronic kidney disease undergoing maintenance hemodialysis

作　　者：胡梦天 闫文静 Hu Meng-tian;Yan Wen-jing(Department of Nephrology,Suzhou Ninth People’s Hospital,Suzhou 215000,China)

机构地区：[1]苏州市第九人民医院肾内科,苏州215000

出　　处：《中国药物应用与监测》2024年第6期713-716,共4页Chinese Journal of Drug Application and Monitoring

摘　　要：目的探讨帕立骨化醇联合碳酸镧治疗慢性肾脏病矿物质与骨代谢异常维持性血液透析患者矿物质与骨代谢异常的效果。方法回顾性分析苏州市第九人民医院2022年6月至2024年3月收治的慢性肾脏病矿物质与骨代谢异常维持性血液透析患者125例患者的病历资料,根据治疗方案的不同分为骨化三醇组61例(骨化三醇胶囊联合碳酸镧咀嚼片)和帕立骨化醇组64例(帕立骨化醇注射液联合碳酸镧咀嚼片)。对比两组患者临床疗效,血磷、血钙和血清全段甲状旁腺激素(iPTH)水平、超敏C反应蛋白(hs-CRP)、骨代谢指标碱性磷酸酶(ALP)、25-羟基维生素D[25(OH)D]水平及不良反应发生情况。结果治疗后,帕立骨化醇组总达标率、血磷、血钙、iPTH达标率[分别为87.50%(56/64)、90.63%(58/64)、87.50%(56/64)、92.19%(59/64)]均高于骨化三醇组[70.49%(43/61)、73.77%(45/61)、70.49%(43/61)、70.49%(43/61)](χ^(2)=5.484、6.118、5.484、9.791,均P<0.05)。治疗后,两组血清学指标均较治疗前改善,且帕立骨化醇组的血钙水平[(2.46±0.32)mmol·L^(-1)]高于骨化三醇组[(2.31±0.29)mmol·L^(-1)],血磷、iPTH水平[分别为(1.54±0.16)mmol·L^(-1)、(237.81±28.62)pg·mL^(-1)]均低于骨化三醇组[(1.68±0.19)mmol·L^(-1)、(285.64±31.66)pg·mL^(-1)](t=2.742、4.464、8.868,均P<0.05)。治疗后,两组骨代谢指标、炎症因子水平均较治疗前改善,且帕立骨化醇组的25(OH)D水平[(32.98±4.53)ng·mL^(-1)]高于骨化三醇组[(28.96±4.18)ng·mL^(-1)],ALP、hs-CRP水平[分别为(63.77±5.21)U·L^(-1)、(10.06±1.32)mg·L^(-1)]均低于骨化三醇组[(71.24±6.89)U·L^(-1)、(14.51±1.49)mg·L^(-1)](t=5.149、6.858、17.694,均P<0.05)。两组不良反应发生率对比差异无统计学意义(P>0.05)。结论相较于碳酸镧结合骨化三醇,碳酸镧结合帕立骨化醇在慢性肾脏病矿物质与骨代谢异常维持性血液透析患者治疗中的临床治疗效果更佳,能够更有效地调控血钙、Objective To investigate the clinical efficacy of paricalcitol combined with lanthanum carbonate in the treatment of mineral and bone metabolism disorder in patients with chronic kidney disease receiving maintenance hemodialysis.Methods A retrospective analysis was conducted on 125 patients with chronic kidney disease complicated with mineral and bone metabolism disorder undergoing maintenance hemodialysis in Suzhou Ninth People’s Hospital from June 2022 to March 2024.According to different treatment plans,they were divided into the calcitriol group of 61 cases(bone Cheatriol capsules combined with lanthanum carbonate chewable tablets),and the paricalcitol group of 64(paricalcitol injection combined with lanthanum carbonate chewable tablets).The levels of blood phosphorus,blood calcium,serum intact parathyroid hormone(iPTH)levels,high-sensitivity C-reactive protein(hs-CRP),alkaline phosphatase(ALP),25-Hydroxyvitamin D(25(OH)D)and occurrence of adverse reactions were compared between the two groups.Results After treatment,the overall achievement rate,serum phosphorus,serum calcium,and iPTH achievement rates in the paricalcitol group were 87.50%(56/64),90.63%(58/64),87.50%(56/64),and 92.19%(59/64),respectively,all of which were higher than those of the calcitriol group at 70.49%(43/61),73.77%(45/61),70.49%(43/61),and 70.49%(43/61),respectively(χ2=5.484,6.118,5.484,9.791,all P<0.05).Both groups showed improvements in serological indicators after treatment.The paricalcitol group had higher blood calcium levels((2.46±0.32)mmol·L^(-1))than the calcitriol group((2.31±0.29)mmol·L^(-1)),and lower blood phosphorus and iPTH levels((1.54±0.16)mmol·L^(-1),(237.81±28.62)pg·mL^(-1))as compared with the calcitriol group((1.68±0.19)mmol·L^(-1),(285.64±31.66)pg·mL^(-1))(t=2.742,4.464,8.868,all P<0.05).Both groups also showed improvements in bone metabolism indicator and inflammatory factor levels after treatment as compared with those before treatment.The paricalcitol group had higher 25(OH)D levels((32.98±4.53)ng�

关 键 词：骨化三醇 帕立骨化醇 碳酸镧 血液透析 慢性肾脏病 矿物质与骨代谢异常 

分 类 号：R692[医药卫生—泌尿科学]