西那卡塞治疗血液透析患者继发性甲状旁腺功能亢进的临床观察

    Clinical observation of Cinacalcet in the treatment of secondary hyperparathyroidism in hemodialysis patients

    • 摘要: 目的 探讨西那卡塞治疗维持性血液透析(MHD)患者继发性甲状旁腺功能亢进(SHPT)的临床疗效。方法 选择武汉市第五医院收治的98例并发SHPT的MHD患者,采用随机数字表法随机分为观察组(n=49)与对照组(n=49)。对照组给予磷结合剂、维生素D类似物等常规治疗,观察组在对照组基础上给予西那卡塞治疗。对比2组患者SHPT的临床疗效,并比较2组患者治疗前后尿素氮、血肌酐、尿素清除指数的变化。结果 观察组的治疗有效率为87.8%,显著高于对照组的67.3%(P<0.05)。与治疗前比较,2组患者治疗后血钙、血磷、碱性磷酸酶、全段甲状旁腺素均显著降低(P<0.05);治疗后组间比较,观察组血钙水平、血磷、碱性磷酸酶、全段甲状旁腺素也显著低于对照组,差异具统计学意义(P<0.05)。2组患者治疗前后尿素氮、血肌酐、尿素清楚指数无统计学意义(P>0.05);治疗后2组甲状旁腺体积均较治疗前显著减小(P<0.01),且观察组治疗后显著小于对照组(P<0.01)。对照组不良反应发生率为40.8%,显著高于观察组的14.3%(P<0.01)。结论 西那卡塞用于MHD患者SHPT具有理想疗效,能够显著降低甲状旁腺素水平,同时缩小甲状旁腺体积,值得临床推广。

       

      Abstract: Objective To discuss the clinical effects of Cinacalcet——a calcium sensitive receptor agonist in maintenance hemodialysis (MDH) patients with secondary hyperparathyroidism (SHPT).Methods Ninety-eight MDH patients with SHPT admitted at the Fifth Hospital of Wuhan were divided into the observation group (n=49) and the control group (n=49). The patients in the control group were treated with conventional treatments such as phosphate binding agent, vitamin D analogue, and those in the observation group were given Cinacalcet besides the treatments in the control group. The clinical effects were compared between the two groups. The changes in blood urea nitrogen, creatinine and KT/V were compared between the two groups.Results The effective rate in the observation group was 87.8%, significantly higher than 67.3% in the control group (P<0.05). Blood calcium phosphorus, ALP, and iPTH levels in the two groups were significantly reduced after the treatment (P<0.01), and those in the observation group were significantly lower than in the control group (P<0.01). There was no significantly difference in BUN, SCr, and KT/V between the two groups (P>0.05). The size of the parathyroid glands was significantly smaller after treatment than before treatment in both two groups (P<0.01), and that in the observation group was significantly smaller than in the control group (P<0.01). The incidence of adverse reactions in the observation group was 14.3%, significantly lower than 40.8% in the control group (P<0.01).Conclusions Cinacalcet has exactly effective in MDH patients with SHPT. Cinacalcet can effectively reduce the level of parathyroid hormone and the size of the parathyroid glands, with less adverse reactions, and is worthy of promotion.

       

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