纠正继发性甲状旁腺功能亢进对维持性血液透析患者心脏结构和功能的影响

EFFECT OF 1,25(OH)_2-VITAMIN D_3 ON CARDIAL STRUCTURE AND FUNCTION OF MAINTENANCE HEMODIALYSIS PATIENTS WITH SECONDARY HYPERPARATHYROIDISM

目的探讨应用活性维生素D3纠正继发性甲状旁腺功能亢进(SHPT)对维持性血液透析(MHD)患者心脏结构和功能的影响。方法56例MHD患者均符合SHPT诊断标准,采用低钙透析液稳定透析3个月以上,随机分为A组(29例)和B组(27例),测定血钙(Ca)、磷(P)、甲状旁腺素(iPTH)。A组每日午饭中嚼服碳酸钙600mg,B组在此基础上服用活性维生素D3,2～3μg/周,分2～3次于透析后当晚口服,二组连续用药12个月,当Ca>10.2mg/dl或Ca×P≥55mg2/dl2调节药物剂量。分别于实验开始前及6个月、12个月行心脏多普勒超声检查。结果于实验6个月、12个月后,B组iPTH平均值较A组下降明显(P<0.05,P<0.01)。心脏结构和功能比较,治疗前左室肥厚(LVH)、射血分数(EF),舒张早期和舒张晚期二尖瓣口最大血流速度之比(E/A)等指标二组之间差异无统计学意义(P>0.05),治疗6个月、12个月后,A组上述各指标无明显变化(P>0.05,P>0.05),B组随治疗时间的延长上述指标明显好转,差异有统计学意义(P<0.05和P<0.01)。结论活性维生素D3不仅可以减轻MHD患者SHPT,而且有助于改善SHPT患者的心脏结构和功能。

Objective To study the effect of 1,25（OH）2 - vitamin D3 on eardial structure and function in maintenance hemodialysis （MHD） patients with secondaryhyperparathyroidism（SHPT）. Methods 56 MHD patients, who met standards of SHPT receiving reduced calcium dialysate for more than 3 months, were randomly assigned into Group A （twenty- nine cases） and Group B（twenty- seven cases）. The patients were given calcium carbonate （600mg） during the time of lunch every day in Group A, and 1,25（OH）2 - Vitamin D3 （2-3μg/w） besides the same dosage of calcium carbonate in Group B. Serum total calcium, serum phosphate, immunoreactive parathyroid hormone（iPTH） were examined every month, all patients were checked up with doppler ultrasonography to reflect cardial structure and function at month 0,6,12, the full course of study was 12 months. Results There was significant difference level of iPTH between two groups at 6 and 12 month（P〈0.05, P〈0.01）. Compared with beginning,there was no significance in Group A about left ventricular hypertrophy （ LVH ）, mitral valve anterior leaf EF slope and E/A ratio of mitral flow spectrum after 6 and 12 months （P〉0.05, P〉0.05 ）;the parameters of left ventricular structure and function were improved significantly in Group B after 6 and 12 months than those in beginning （P〈0.05,P〈0. 01）. Conclusion Not only could 1,25（OH）2 -Vitamin D3 reduce prevalence rate of SHPT in MHD patients,and it might be helpful to improve cardial structure and function in SHPT patients.