西那卡塞联合小剂量骨化三醇治疗重度继发性甲状旁腺功能亢进的效果及其对骨代谢的影响

发布时间：2018-08-14 18:41

【摘要】：目的:探讨西那卡塞联合小剂量骨化三醇治疗维持性血液透析重度继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)患者的临床疗效及其对骨代谢的影响。方法:选择中南大学湘雅二医院肾内科血液透析中心维持性血液透析6个月的重度SHPT患者30例,所有患者全段甲状旁腺激素(intact parathyroid hormone,iPTH)600 pg/mL;B超示甲状旁腺有1个以上结节增生;既往药物治疗无效。给予口服西那卡塞25~75 mg/d,同时服用骨化三醇0.5μg/d。比较治疗前和治疗后血钙、血磷、iPTH以及骨代谢指标和骨密度的变化,观察患者治疗前有关的临床症状及治疗后改善情况。结果:入组30例患者,基线iPTH(1 787.3±1 321.0)pg/mL,血钙(2.54±0.19)mmol/L,血磷(2.06±0.15)mmol/L。治疗2周后患者血磷下降20%;iPTH治疗1个月后较服药前降低35%,3个月后降低70%;治疗1个月后血钙和血磷分别降至(2.39±0.17)和(1.56±0.50)mmol/L(P0.05),患者症状明显缓解,12个月后上述指标保持稳定;治疗6个月后骨代谢指标显示碱性磷酸酶、骨钙素、β胶原特殊序列水平分别较治疗前下降50%,37%和49%;患者的骨密度年下降幅度受到抑制。无严重不良反应发生。结论:西那卡塞联合小剂量骨化三醇可以改善维持性血液透析患者重度SHPT高钙、高磷及高iPTH状态,缓解临床症状,改善骨质代谢,可以作为治疗重度SHPT的选择。
[Abstract]:Objective: to investigate the clinical effect of cilazepine combined with low dose ossification triol in the treatment of severe secondary hyperparathyroidism (secondary hyperparathyroidism) on maintenance hemodialysis and its effect on bone metabolism. Methods: thirty patients with severe SHPT who had maintained hemodialysis for 6 months in the Department of Hemodialysis, Xiangya second Hospital, Central South University were selected. All the patients had 600 PG / mL of the whole parathyroid hormone (intact parathyroid hormoneiPTH, and more than one nodular hyperplasia in the parathyroid gland was detected by B-mode ultrasound. Previous drug therapy was ineffective. It was administered orally for 2, 575 mg / d of cinacarcetin and 0.5 渭 g / d of ossifying triol. Before and after treatment, the changes of serum calcium, plasma phosphorous iPTH, bone metabolism index and bone mineral density were compared, and the clinical symptoms before and after treatment were observed and the improvement after treatment was observed. Results: the baseline iPTH, calcium and phosphorus were (1 787.3 卤1 321.0) mg / mL, (2. 54 卤0. 19) mmol / L and (2. 06 卤0. 15) mmol / L, respectively. After 2 weeks of treatment, the levels of serum phosphorus in patients decreased by 20%. After 1 month treatment, the levels of serum phosphorus and calcium decreased to (2. 39 卤0. 17) and (1. 56 卤0. 50) mmol/L (P0.05) respectively. The above indexes remained stable 12 months after treatment, and the levels of serum phosphorus were decreased to (2. 39 卤0. 17) and (1. 56 卤0. 50) mmol/L after 1 month of treatment, respectively. After 6 months of treatment, the levels of alkaline phosphatase (ALP), osteocalcin (BGP) and 尾 collagen specific sequence decreased by 50% and 49%, respectively, and the annual decrease of bone mineral density (BMD) was inhibited. No serious adverse reactions occurred. Conclusion: the combination of silacarcetin and low dose ossification triol can improve the state of high calcium, high phosphorus and high iPTH in patients with maintenance hemodialysis, relieve clinical symptoms and improve bone metabolism. It can be used as the choice of treatment for severe SHPT.
【作者单位】：中南大学湘雅二医院肾内科中南大学肾脏病研究所;
【基金】：湖南省自然科学基金(2017JJ2352)~~
【分类号】：R581.1;R692.5

【相似文献】