尿毒症透析患者不同剂量钙三醇治疗继发性甲状旁腺功能亢进的疗效观察

The curative effect of different dose of calcitriol on uremic hemodialysis patients with second dary hyperparathyroidism

目的比较常规剂量钙三醇与较大剂量冲击疗法防治尿毒症维持性透析患者继发性甲状旁腺功能亢进（SHPT）的疗效。方法48例尿毒症透析患者，分常规治疗组（A组）22例，钙三醇0．25～0．5μg／d，同时补钙，治疗时间6个月；未治疗组（B组）21例，皆因经费困难不愿意治疗；冲击治疗组（C组）21例（其中16例来自A组），钙三醇每周4μg，分2次于血液透析后口服，观察3个月。结果A组与B组比较，血清甲状旁腺激素（PTH）、碱性磷酸酶（AKP）差异无统计学意义（P〉0．05），但A组中，低血钙、高血磷得到部分纠正（P〉0．05），骨痛、肌肉抽搐、无力、皮肤瘙痒等症状均有改善。结论较大剂量间歇冲击治疗能有效治疗尿毒症血液透析患者SHPT。

Objective To compare the therapeutic effect of routine dose of calcitriol and large dose impulsion therapy on hemodialysis patients with secondary hyperparathyroidism （SHPT）. Methods 48 uremic hemodialysis patients were divided into group A（routine group, n = 22） and group B（control group, n = 21 ）. In group A,22 patients were administered with calcitriol for 6 months at the dosage of 0.25 --0.5μg/d,adding calcium agents simultaneously;the patients in group 13 were not given calcitriol for economic reason. In group C,21 patients were given calcitriol twice a week at the dosage of 2μg/time after hemodialysis for 3 months. Results Comparing to group B, serum PTH, AKP in group A had no significant difference, but serum hypocalcium and hyperphasphate were partly corrected,symptoms of bone pain, muscular convulsion and skin pruriter were improved. Comparing to group A, serum hypocalcium and hyperphasphate in group C were corrected,serum PTH,AKP were significantly decreased（ t = 2. 031, P 〈 0.05 ; t = 3. 317, P 〈 0. 001 ）, and no hypercalcium occurred. Conclusion Routine dose of calcitriol can not control uremic-SHPT, while impulsion therapy with lower dose oral calcitriol is effective and safe.