西那卡塞联合帕立骨化醇治疗血液透析患者继发性甲状旁腺功能亢进的疗效与安全性

摘要

Objective To evaluate the efficiency and security of paricalcitol and cinacalcet in treating secondary hyperparathyroidism in maintenance hemodialysis(MHD)patients.Methods A total of 19 MHD patients with intact parathyroid hormone(iPTH)above 600 pg/mL were given paricalcitol and cinacalcet.The full course of the study was 12 weeks.Levels of serum iPTH,calcium,phosphorus and alkaline phosphatase(AKP) were tested before and after 2,4,8 and 12 weeks during the study period.Results The serum iPTH level was decreased slightly at 2nd week after treatment, there was no significant difference (P>0.05), and it was obviously decreased from the 4th week (P<0.05).The serum iPTH level was (841.78±730.17) pg/mL at 12th weeks (P<0.01). The serum calcium level was obviously decreased after treatment (P<0.05), but there was no significant difference in the levels of serum AKP, phosphorus and calcium phosphorus product before and after treatment (P>0.05).The tolerance of the patients was good during the treatment.Conclusion The treatment of paricalcitol and cinacalcet for secondary hyperparathyroidism in MHD was effective and safe.%目的 观察西那卡塞联合帕立骨化醇治疗维持性血液透析患者继发性甲状旁腺功能亢进症(Secondary hyperparathyroidism,SHPT)的疗效及安全性.方法 选择我科血液净化中心进行维持性治疗的19例患者,血全段甲状旁腺素(Intact parathyroid hormone,iPTH)≥600 pg/mL,根据iPTH水平使用帕立骨化醇和西那卡塞治疗,共观察12周.分别于治疗前及治疗后第2、4、8、12周测定患者的iPTH、血钙、血磷、碱性磷酸酶(Alkaline phosphatase,AKP)水平.结果 治疗后第2周,19例患者的血清iPTH水平开始下降,但差异无统计学意义(P>0.05).从治疗后第4周开始,iPTH水平与治疗前比较差异有统计学意义(P<0.05);治疗后第12周时,下降至(841.78±730.17) pg/mL.治疗后,血钙水平显著降低(P<0.05).治疗前后AKP、血磷、钙磷乘积水平比较差异无统计学意义(P>0.05).治疗过程中,患者耐受性良好.结论 西那卡塞联合帕立骨化醇治疗维持性血液透析患者SHPT安全、有效.