骨化三醇治疗维持性血液透析患者甲状旁腺功能亢进的临床疗效

发布时间：2018-07-16 08:15

【摘要】：目的探讨骨化三醇注射液和口服制剂冲击治疗维持性血液透析(MHD)患者继发甲状旁腺功能亢进(SHPT)的疗效及安全性。方法收集安徽医科大学第二附属医院MHD并SHPT且不伴有高血钙、高血磷的患者40例,随机分为骨化三醇静脉治疗组(A组)和口服冲击组(B组),疗程12周。分别于治疗前、治疗后4、8和12周测定两组血清全段甲状旁腺激素(i PTH)、碱性磷酸酶(AKP)、钙、磷水平,观察症状改善及不良反应。结果 (1)与治疗前相比,治疗4周后,两组i PTH水平均明显降低(P0.05);两组在治疗后AKP均有下降趋势,12周后,均出现明显下降(P0.05)。(2)与B组比较,治疗第8周,A组i PTH水平降低更为显著,并在后续的治疗中维持低于B组水平,差异有统计学意义(P0.05)。(3)血钙变化:两组在治疗后均有血钙升高趋势,B组血钙改变明显,差异有统计学意义(P0.05)。(4)血磷水平治疗前后两组差异均无统计学意义。(5)两组临床症状如骨痛、不宁腿、皮肤瘙痒和贫血等均有不同程度改善,其中A组瘙痒改善显著(P0.05)。结论骨化三醇口服和静脉冲击治疗均能有效降低MHD并SHPT患者的PTH和AKP,改善骨痛及瘙痒等症状。高钙血症是其主要的副作用。与口服冲击治疗比较,静脉注射骨化三醇疗效更为迅速及显著,较少引起高钙血症,MHD患者使用安全方便,透析结束时给药依从性较好。
[Abstract]:Objective to investigate the efficacy and safety of ossifying triol injection and oral preparation in the treatment of secondary hyperparathyroidism (SHPT) in patients with maintenance hemodialysis (MHD). Methods Forty patients with MHD and SHPT without hypercalcemia and high blood phosphorus were randomly divided into two groups: group A (group A) and group B (oral shock group). The course of treatment was 12 weeks. The serum levels of total parathyroid hormone (I PTH), alkaline phosphatase (AKP), calcium and phosphorus were measured before treatment, 4 weeks and 12 weeks after treatment, respectively. Results (1) after 4 weeks of treatment, the level of I). (in both groups was significantly lower than that before treatment (P0.05), and there was a tendency to decrease in both groups after 12 weeks of treatment (P0.05), which was significantly lower than that in group B (P0.05). At the 8th week of treatment, the level of I PTH in group A was significantly lower than that in group B, which was significantly lower than that in group B (P0.05). (3). The difference was statistically significant (P0.05). (4). (5) the clinical symptoms such as bone pain, restless legs, pruritus and anemia were improved in two groups, especially in group A (P0.05). Conclusion both oral and intravenous pulse therapy can effectively reduce PTH and AKP in patients with MHD and SHPT, and improve the symptoms of bone pain and pruritus. Hypercalcemia is its main side effect. Compared with oral shock therapy, intravenous injection of ossification triol was more rapid and significant, less caused hypercalcemia and MHD patients safe and convenient, and the drug compliance at the end of dialysis was better.
【作者单位】：安徽医科大学第二附属医院肾内科;安徽省妇幼保健院肾内科;
【基金】：安徽医科大学2015年度校临床科学研究项目(No:2015xkj110) 安徽省公益性研究联动项目(No:1604f0804021)
【分类号】：R459.5;R582.1

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