大剂量骨化三醇冲击治疗尿毒症继发性甲状旁腺功能亢进症的效果

Effect of high-dose calcitriol shock therapy on secondary hyperparathyroidism in uremia

目的探讨大剂量骨化三醇治疗尿毒症继发性甲状旁腺功能亢进症的效果。方法回顾性分析江苏省宿迁市泗阳县人民医院2017年1月至2018年2月收治的92例行血液透析的尿毒症继发性甲状旁腺功能亢进症患者的临床资料,患者均给予实验室检查、影像学检查,甲状旁腺激素(PTH)均>600 pg/ml。根据治疗方法的不同分为研究组和对照组,每组46例。研究组给予大剂量骨化三醇(2μg)冲击疗法,对照组给予常规剂量(0.5μg)治疗,观察两组治疗前后的PTH、血钙、血磷水平和治疗总有效率。结果治疗前,两组患者PTH、血钙与血磷比较,差异无统计学意义(P>0.05);治疗后,研究组患者PTH、血磷水平低于对照组,血钙水平高于对照组,差异有统计学意义(P<0.05)。研究组总有效率为93.48%,高于对照组的78.26%,差异有统计学意义(P<0.05)。随访6个月,对照组未出现药物不良反应;研究组出现眩晕2例,恶心4例,一过性高钙血症1例,均自然缓解,未见肝肾功能明显减退等不良反应。结论大剂量骨化三醇在尿毒症继发性甲状旁腺功能亢进症治疗中的应用能够降低患者的PTH和血磷水平,升高血钙水平,具有一定的安全性。

Objective To investigate the effect of high-dose calcitriol shock therapy on secondary hyperparathyroidism in uremia.Methods Clinical data of 92 uremia patients with secondary hyperparathyroidism treated in People’s Hospital of Siyang County from January 2017 to February 2018 were retrospectively analyzed.All patients were given laboratory examination and imaging examination,and their levels of parathyroid hormone(PTH)were higher than 600 pg/ml.According to the different treatment methods,they were divided into study group and control group,46 cases in each group.The study group was given high-dose calcitriol shock therapy(2μg),and the control group was given conventional dose therapy(0.5μg).PTH,blood calcium and blood phosphorus levels before and after treatment in the two groups were observed,and the total effective rates of treatment were compared.Results Before treatment,there was no significant difference in PTH,blood calcium and blood phosphorus between the two groups(P>0.05);after treatment,the PTH and blood phosphorus levels of the study group were lower than those of the control group,and the blood calcium level was higher than that of the control group(P<0.05).The total effective rate of the study group was significant higher than that of the control group(93.48%vs.78.26%,P<0.05).After 6 months of follow-up,no adverse drug reactions occurred in the control group.In the study group,there were 2 cases of dizziness,4 cases of nausea,and 1 case of transient hypercalcemia,and all of them resolved naturally.No adverse reactions such as marked decrease in liver and kidney function were observed.Conclusion The application of high-dose calcitriol in the treatment of secondary hyperparathyroidism in uremia patients can reduce PTH,blood phosphorus levels,and increase blood calcium levels with certain safety.