目的 研究骨化三醇聯(lián)合西那卡塞治療血液透析患者繼發(fā)性甲狀旁腺功能亢進的臨床療效。方法 選取2008年1月—2014年12月天津市第一中心醫(yī)院收治的血液透析后繼發(fā)性甲狀旁腺功能亢進患者100例,隨機分為對照組和治療組,每組各50例。對照組患者進食時口服鹽酸西那卡塞片,初始劑量為25 mg/d。隨后根據(jù)患者耐受情況,每2～4周調整1次劑量,最大劑量75 mg/d。治療組在對照組治療基礎上口服骨化三醇膠丸,初始計量為0.25 μg/d,3次/周,頻率不超過每2天1次,每2～4周調整1次劑量。兩組均連續(xù)治療3個月。觀察兩組患者的臨床療效,同時比較治療前后兩組患者血肌酐(Scr)、血尿素氮(BUN)、尿素清除指數(shù)(KT/V)、鈣(Ca)、磷(P)、堿性磷酸酶(ALP)、全段甲狀旁腺激素(iPTH)、甲狀旁腺體積的變化情況。結果 治療后,對照組和治療組的總有效率分別為82.0%、94.0%,兩組比較差異有統(tǒng)計學意義(P<0.05)。治療后,兩組患者的BUN、Scr和Kt/V較治療前均無顯著差異;治療后,兩組患者Ca顯著升高,P、ALP、iPTH、甲狀旁腺體積均顯著降低,同組治療前后差異有統(tǒng)計學意義(P<0.05);且治療組這些觀察指標的改善程度優(yōu)于對照組,兩組比較差異具有統(tǒng)計學意義(P<0.05)。對照組和治療組不良反應發(fā)生率分別為18.0%、8.0%,兩組比較差異具有統(tǒng)計學意義(P<0.05)。結論 骨化三醇聯(lián)合西那卡塞治療血液透析患者繼發(fā)性甲狀旁腺亢進具有較好的臨床療效,可降低甲狀旁腺素,縮小甲狀旁腺體積,并降低不良反應的發(fā)生率,具有一定的臨床推廣應用價值

Objective To observe the clinical effect of calcitriol combined with cinacalcet in the treatment of hemodialysis patients with secondary hyperparathyroidism. Methods Hemodialysis patients (100 cases) with secondary hyperparathyroidism in Tianjin First Center Hospital from January 2008 to December 2014 were randomly divided into control and treatment groups, and each group had 50 cases. The patients in the control group were po administered with Cinacalcet Hydrochloride Tablets, and the initial dosage was 25 mg/d. The dosage was adjusted according to the patient tolerance, once every 2 — 4 weeks, and the maximum dosage was 75 mg/d. The patients in treatment group were po administered with Calcitriol Soft Capsules on the basis of the control group, and the initial dosage was 0.25 μg/d, three times weekly. The frequency was no more than once every two days, and the dosage was adjusted once every 2 — 4 weeks. The patients in two groups were treated for 3 months. After treatment, the clinical efficacy was evaluated, and the changes of Scr, BUN, KT/V, Ca, P, ALP, iPTH and volume of parathyroid gland in two groups before and after treatment were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 82.0% and 94.0%, respectively, and there were differences between two groups (P < 0.05). After treatment, BUN, SCr, and Kt/V in two groups had no significant difference compared before treatment. Ca in two groups was significantly increased, P, ALP, iPTH, and volume of parathyroid gland in two groups were significantly reduced, and the difference was statistically significant in the same group (P < 0.05). After treatment, the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05). The incidence of adverse reactions in the control and treatment groups were 18.0% and 8.0%, respectively, and there were differences between two groups (P < 0.05). Conclusion Calcitriol combined with cinacalcet has clinical curative effect in the treatment of hemodialysis patients with secondary hyperparathyroidism, and can reduce parathyroid hormone and parathyroid gland volume, also can reduce the incidence of adverse reactions, which has a certain clinical application value.

天津市衛(wèi)生局科技基金項目(2013KZ024)