西那卡塞联合小剂量骨化三醇治疗终末期肾病继发性甲状旁腺功能亢进的临床疗效观察

Clinical efficacy of cinacalciclovir hydrochloride combined with low - dose calcitriol in the treatment of patients with secondary hyperparathyroidism of end stage renal disease

目的探讨西那卡塞联合小剂量骨化三醇治疗终末期肾病继发甲状旁腺功能亢进（甲旁亢）的疗效。方法采用前瞻性分析的研究方法，纳入温州市中西医结合医院肾内科2015年4月至2017年8月诊断为终末期肾病且继发甲旁亢患者共计129例，采用随机数字表法分为三组，各43例，A组采用西那卡塞治疗，B组采用骨化三醇治疗，C组联合西那卡塞与小剂量骨化三醇治疗，疗程为3个月，分别在治疗前及治疗后检测各组的血磷和血钙含量，并检测全段甲状旁腺激素水平和全段甲状旁腺激素清除率，了解各组的治疗效果。结果A组治疗后血钙、血磷水平、全段甲状旁腺激素水平较治疗前下降，差异均有统计学意义（t=3．269、2．263、4．233，均P〈0．05）；B组全段甲状旁腺激素明显下降，血钙、血磷较治疗前明显升高，差异均有统计学意义（t=2．827、2．386、3．342，均P〈0．05）；C组血磷、全段甲状旁腺激素水平治疗前明显下降，差异均有统计学意义（t=3．085、5．142，均P〈0．05），血钙水平未见明显影响（t=0．258，P〉0．05）。全段甲状旁腺激素水平B组〉A组〉C组，全段甲状旁腺激素清除率方面C组〉A组〉B组，组间差异有统计学意义（t=3．642、3．263，均P〈0．05）；血钙水平治疗后组间比较，差异均有统计学意义，B组〉C组〉A组，血磷水平治疗后组间比较，B组〉A组〉C组组问差异均有统计学意义（t=3．265、3．332，均P〈0．05）。结论终末期肾病继发性甲旁亢采用联合西那卡塞与小剂量骨化三醇治疗，可明显降低患者甲状旁腺激素水平和血磷水平，不影响血钙浓度。

Objective To investigate the effect of cinacalcet combined with low - dose calcitriol in the treatment of patients with secondary hyperparathyroidism of end - stage renal disease. Methods A prospective analysis was conducted in 129 patients with end - stage renal disease and secondary hyperparathyroidism from April 2015 to August 2017 in the Department of Nephrology of Integrative Medicine Hospital of Wenzhou City, Zhejiang Province. The patients were randomly divided into 3 groups：group A received cinacalcet, group B received calcitriol, group C received cinacalcet and low- dose calcitriol for 3 months, respectively. Before and after treatment, the levels of serum phosphorus and serum calcium in the three groups were measured. The levels of parathyroid hormone and the parathyroid hormone clearance rate were measured to find out the therapeutic effect. Results The levels of serum calcium, phosphorus and total parathyroid hormone in group A were significantly lower than those before treatment（ t = 3. 269,2. 263,4. 233, all P 〈 0.05 ）. PTH was significantly decreased, blood calcium and phosphorus significantly in- creased compared with those before treatment, the differences were statistically significant （ t = 2. 827,2. 386,3. 342, all P 〈 0.05）. The phosphorus, total parathyroid hormone levels of group C were significantly decreased （ t = 3. 085,5. 142, all P 〈 0.05 ）, and. no significant change iff serum calcium level（ t = 0. 258, P 〉 0. 05 ）. The total parathyroid hormone level：group B 〉 group A 〉 group C, the whole parathyroid hormone clearance rate：group C 〉 group A 〉 group B, the differences were statistically significant （ t = 3. 642,3. 263, all P 〈 0.05 ）. After treatment, the serum calcium level among the three groups had statistically significant difference, group B 〉 group C 〉 group A,the serum phosphorus level among the three groups after treatment had statistically significant difference,group B 〉 group A 〉 group C （ t = 3. 265,3. 332, all P 〈 0. 05 ）. Conclusion The combined use of cinacalcet and low - dose calcitriol in the treatment of secondary hyperparathyroidism in patients with end - stage renal disease can significantly reduce the level of parathyroid hormone and serum phosphorus, and without affecting serum calcium concentration.