维持性血液透析患者继发性甲状旁腺功能亢进的治疗观察

The clinical study of combining reduced calcium dialysate and 1,25(OH)_2D_3 with calcium carbonate for treating secondary hyperparathyroidism in maintenance hemodialysis patients.

目的研究低钙透析联合1,25(OH)2D3及碳酸钙治疗维持性血液透析患者继发性甲状旁腺功能亢进的有效性和安全性。方法选择山东省千佛山医院肾脏病血液净化中心23例血液透析患者,校正血钙≥8.00mg/dl,iPTH>300pg/ml,分为Ⅰ组[iPTH(300～600)pg/ml]和Ⅱ组(iPTH600～1000pg/ml),起始量分别给予1,25(OH)2D32～3μg/w和4～6μg/w,分2～3次较大剂量间断口服治疗,配合碳酸钙口服降磷,并联合低钙透析(透析液钙浓度为1.25mmol/L),总观察期20周。监测治疗前后患者血钙、磷、钙磷乘积、iPTH、碱性磷酸酶(AKP)等指标及药物用量变化情况。结果为期20周的治疗显著降低血液透析患者血磷、钙磷乘积、iPTH水平,血钙水平在治疗过程中保持稳定。不良反应较小且均可耐受。结论合理调整活性维生素D用量,配合碳酸钙及低钙透析可有效控制血液透析患者继发性甲状旁腺功能亢进,并且在治疗的早期疗效更显著,安全性良好。

Objective To evaluate the efficiency and security of combining reduced calcium dialysate and 1, 25（0H）2D3 with calcium carbonate on treating secondary hyperparathyroidism in maintenance hemodialysis （MHD） patients. Methods Twenty-three MHD patients with corrected serum calcium above 8. 00mg/dl and intact PTH above 300pg/ml, were divided into 2 groups. 0ne group with iPTH 300-600pg/ml received 1, 25（0H）2D3 2-3 μ g/w, another group with iPTH 600-1000pg/ml received 1, 25（OH）2D3 4-6μ g/w. Calcium carbonate and reduced calcium dialysate （dialysate Ca^2＋：1. 25mmol/l） were used at the same time. The full course of study was 20 weeks. The serum calcium, phosphorus, calcium-phosphorus product, iPTH and AKP were used at the same time and the variance of drug dosage b, efore and during the study period were recorded. Results After 20 weeks＇ treatment, the serum phosphorus, calcium-phosphorus product and iPTH level were decreased significantly in the secondary hyperparathyroidism patients, the serum calcium level was stable during the study period. Side effects were minimal and could be well tolerated. Conclusion 1, 25（OH）2D3 with reasonably adjusted dosage combined with calcium carbonate and reduced calcium dialysate are effecfive and safe therapy ofr secondary hyper- parathyroidism.