血液透析患者静脉注射1,25二羟胆骨化醇治疗继发性甲状旁腺功能亢进疗效

EFFECT OF INTRAVENOUS 1,25 DIHYDROXY CHOLECALCIFEROL THERAPY ON HEMODIALYSIS PATIENTS WITH SECONDARY HYPERPARATHYROIDISM

目的：观察尿毒症患者继发性甲状旁腺功能亢进使用大剂量１，２５二羟胆骨化醇静脉冲击治疗的疗效。方法：选择１０例维持性血液透析继发性甲状旁腺功能亢进（血清全段甲状旁腺激素（ｉＰＴＨ）＞１００ｎｇ／Ｌ）的患者，以１，２５二羟胆骨化醇注射液（溉纯，Ｃａｌｃｉｊｅｘ）治疗０５μｇ／次２周，１μｇ／次，２周；２μｇ／次，８周；均为静脉注射，２次／周，血液透析完毕后经静脉导管注入。观察治疗前后的ｉＰＴＨ、血Ｃａ、血Ｐ、ＡＫＰ、ＡＬＴ和ＳＣｒ。结果：患者ｉＰＴＨ在治疗４周、８周、１２周后较治疗前分别下降１９６％、２４７％、４８６％；在治疗８周、１２周后的下降有显著性差异（Ｐ＜００５）。血清Ｃａ在治疗后较治疗前显著升高（Ｐ＜００５），且均达到正常范围；血清Ｐ、ＡＫＰ均有所下降，但差异不显著。结论：大剂量１，２５二羟胆骨化醇静脉冲击治疗继发性甲状旁腺功能亢进安全有效、作用快，对甲状旁腺作用直接，但不能显著降低血Ｐ，如果治疗前Ｃａ×Ｐ＞６０。

Objective:To study the effect of intravenous calcijex pulse therapy on secondary hyperparathyroidism in ten patients with uremia.Methods:Ten regular hemodialysis patients with secondary hyperparathyoidism(2°HPT)(intact parathormone>100 ng/L) were treated with 1,25 dihydroxy cholecalciferol injection(calcijex) intravenously at the end of each hemodialysis with a dose of 0 5 μg,1 μg Biw for two weeks respectively ,and followed by 2 μg Biw for eight weeks.Intact parathormone(iPTH) was detected before and every four weeks after treatment.Serum calcium,phosphate,alkaline phosphatase(AKP) were detected every two weeks.Results:iPTH level declined by 19 6%,24 7% and 48 6% respectively at the week four,eight,and 12,with a significant difference at week eight and 12( P <0 05).Compared with that before treatment,serum calcium increased significantly( P <0 05) after calcijex therapy,and all reached normal levels.Serum phosphate and AKP decreased insignificantly.Conclusion:Intravenous pulse therapy on 2°HPT is safe,effective and quick.Serum phosphate decreased insignificantly indicated that 1,25 dihydroxy cholecalciferol has no effect on serum phosphate.It is recommended to reduce serum phosphate to normal level with phosphate binder when Ca×P>60 before 1,25 dihydroxy cholecalciferol therapy.