活性维生素D联合西那卡塞治疗血液透析继发性甲旁亢的疗效
Effectiveness and safety of activated vitamin D combined with cinacalcet in the treatment of secondary hyperparathyroidism in hemodialysis patients
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摘要: 目的 探讨活性维生素D联合西那卡塞治疗维持性血液透析（MHD）甲状旁腺功能亢进患者的临床疗效及安全性。方法 选择张家港第一人民医院血液透析中心维持性血液透析>3个月（透析频率每周2~3次）的继发性甲状旁腺功能亢进（SHPT）患者30例，在饮食管理和维持性血液透析的基础上给予口服西那卡塞25~75 mg/d，同时服用骨化三醇胶丸0.25 μg/d。治疗6个月，比较治疗前和治疗后1、3、6个月的血钙、血磷、全段甲状旁腺素（iPTH）、甲状旁腺体积的变化，并观察治疗过程中的不良反应，使用SPSS 17.0软件进行统计学分析。结果 30例患者治疗后血磷、iPTH水平、钙磷乘积值均明显低于治疗前，血清钙较治疗前增高（P均<0.05）；治疗1、3、6个月后血钙水平较治疗前升高，各治疗时间段间差异无统计学意义（P均>0.05）；治疗3、6个月后，14例治疗前确诊甲状旁腺增生患者中9例甲状旁腺体积较前减小，治疗前后差异无统计学意义（P均>0.05），5例无明显变化，治疗前未发生甲状旁腺增生的16例患者治疗后均未发现新的甲状旁腺增生。治疗过程中无患者发生严重不良反应。结论 活性维生素D联合西那卡塞治疗MHD的SHPT能有效抑制PTH的分泌，从而改善钙、磷代谢紊乱，抑制或减轻甲状旁腺组织的增生，且不良反应小。仅有部分患者出现恶心、呕吐、腹痛、肌痛，减少剂量后缓解。总体疗效安全可靠，值得临床推广。
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关键词:
- 活性维生素D /
- 西那卡塞 /
- 继发性甲状旁腺功能亢进 /
- 血液透析
Abstract: Objective To explore the effectiveness and safety of activated Vitamin D combined with cinacalcet in the treatment of secondary hyperparathyroidism (SHPT) in maintenance hemodialysis (MHD) patients. Methods Thirty patients with SHPT were enrolled to receive treatment of cinacalcet combined with calcitriol. The duration of MHD was >3 months and the frequency of dialysis was 2-3 times a week. All patients were given cinacalcet 25-75 mg/day and calcitriol 0.25 μg/day. Serum Ca, P, parathyroid hormone (iPTH) and volume of parathyroid glands were measured before and 1, 3 and 6 months after treatment. The drug toxicity and clinical side effects were recorded. The experimental data were analyzed statistically by SPSS 17.0. Results After treatment, serum P, iPTH and Ca×P product decreased significantly, and serum Ca increased obviously, as compared with those before the treatment (P<0.05). After 1, 3 and 6 months of treatment, serum Ca levels increased obviously as compared with those before the treatment. There was no significant difference between each time quantum (P>0.05). After 3 and 6 months of treatment, the volume of parathyroid was reduced in 9 of 14 parathyroid hyperplasia patients, but there was no significant difference before and after treatment (P>0.05). No new parathyroid hyperplasia was found in 16 patients without parathyroid hyperplasia before treatment. There was no severe drug toxicity and clinical side effects in all patients. Conclusions Activated vitamin D combined with cinacalcet can effectively inhibit the secretion of PTH, improve the disturbance of calcium and phosphorus metabolism, and suppress or alleviate the parathyroid hyperplasia, and has no serious adverse reaction. Only a few patients had nausea and vomiting, abdominal pain and myalgia. The overall effect of activated vitamin D combined with cinacalcet is safe and reliable, and it is worthy of clinical promotion. -
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