帕立骨化醇联合西那卡塞对尿毒症继发性甲状旁腺功能亢进患者微炎症状态、碱性磷酸酶及甲状旁腺激素水平的影响

Effect of paricalcitol combined with ciracalcet on micro-inflammatory state and alkaline phosphatase and parathyroid hormone levels in patients with uremic secondary hyperparathyroidism

目的探讨帕立骨化醇联合西那卡塞对尿毒症继发性甲状旁腺功能亢进(SHPT)对患者微炎症状态、碱性磷酸酶(ALP)和甲状旁腺激素(iPTH)水平影响。方法回顾性分析弋矶山医院于2019年6月至2020年12月收治的80例尿毒症SHPT患者的临床资料,其中男性47例,女性33例,年龄(56.8±9.9)岁。运用随机数字表法将患者分为联合组(n=40)与对照组(n=40)。对照组给予帕立骨化醇治疗,联合组在帕立骨化醇基础上结合西那卡塞治疗,两组维持治疗12周。比较两组治疗疗效,治疗前与治疗12周钙磷水平、微炎症水平、ALP、iPTH和甲状旁腺体积变化。结果12周后,联合组治疗总有效率(92.50%)高于对照组(75.00%)(P<0.05)。两组血钙、血磷和钙磷乘积均较治疗前下降(均P<0.05);但联合组降低更加明显(均P<0.05)。两组血清白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α和C反应蛋白(CRP)水平均较治疗前下降(均P<0.05);但联合组下降更加明显(均P<0.05)。两组血清ALP和iPTH水平均低于治疗前(均P<0.05);但联合组较对照组的iPTH水平下降更明显[(326.59±38.39)pg/ml比(483.21±46.56)pg/ml,P<0.05]。两组甲状旁腺体积小于治疗前(P<0.05);但联合组较对照组的甲状旁腺体积降低更明显[(0.79±0.14)mm3比(1.08±0.19)mm3,P<0.05]。结论帕立骨化醇联合西那卡塞对尿毒症SHPT疗效显著,可减轻患者微炎症状态,降低ALP和iPTH水平,并减小甲状旁腺体积。

ObjectiveTo investigate the effect of paricalcitol combined with ciracalcet on the micro-inflammatory state and alkaline phosphatase(ALP)and parathyroid hormone(iPTH)levels in patients with uremic secondary hyperparathyroidism(SHPT).MethodsA total of 80 SHPT patients with uremia treated at Yijishan Hospital from June 2019 to December 2020 were selected,and the patients were randomly divided into a combination group(n=40)and a control group(n=40)using the random number table method.The control group was treated with paricalcitol alone,and the combination group was treated with paricalcitol combined with cinacalcet.The treatment lasted for 12 weeks in both groups.The therapeutic effects and the changes in calcium and phosphorus levels,micro-inflammation indicator levels,ALP,iPTH,and parathyroid gland volume between before treatment and 12 weeks after treatment were compared between the two groups.ResultsAfter 12 weeks of treatment,the total treatment effective rate in the combination group was significantly higher than that of the control group(92.5%vs75.0%,P<0.05).Blood calcium,blood phosphorus,and calcium phosphorus product in both groups decreased after treatment when compared with the values before treatment(P<0.05 for all),but the decreasing trend was more obvious in the combination group than in the control group(P<0.05 for all).Serum levels of interleukin-6,tumor necrosis factor-α,and C reactive protein(CRP)decreased in both groups when compared with those before treatment(P<0.05 for all),but the decreasing trend was more obvious in the combination group(P<0.05 for all).Serum ALP and iPTH levels were both lower than those before treatment in the two groups(P<0.05 for all),but iPTH was significantly lower in the combination group than in the control group[(326.59±38.39)pg/mlvs(483.21±46.56)pg/ml,P<0.05].After 12 weeks of treatment,the volume of the parathyroid glands was lower than that before treatment in both groups(P<0.05 for both),and the volume of the parathyroid glands in the combination group was significantly smaller than that of the control group[(0.79±0.14)mm3vs(1.08±0.19)mm3,P<0.05].ConclusionParicalcitol combined with cinacalcet has a significant therapeutic effect on uremic SHPT,which reduces the micro-inflammatory state of the patients and the levels of ALP and iPTH,as well as the volume of the parathyroid glands.