口服活性维生素D冲击治疗终末期肾衰患者继发性甲状旁腺功能亢进的疗效

Effect of oral administration with active vitamin D on the pulse treatment of secondary hyperparathyroidism in patients with end stage renal failure

目的观察口服活性维生素D冲击治疗终末期肾衰患者继发性甲状旁腺功能亢进(SHPT)的疗效和安全性。方法选择本中心2007年4月至2008年10月终末期肾衰继发性SHPT患者,透析液钙浓度为1.5 mmol·L^(-1),给予口服活性维生素D冲击治疗并完成全部随访的患者91例。终点指标为甲状旁腺激素(iPTH)≤300 ng·L^(-1)或用药足20周。当300<iPTH≤600ng·L^(-1),给予口服活性维生素D每次1～1.5μg,每周2次;当600<iPTH≤1 000 ng·L^(-1),给予口服活性维生素D每次1.5～2.0μg,每周2次;当iPTH>1 000 ng·L^(-1),给予口服活性维生素D每次2.0～2.5μg,每周2次。分别检测治疗前及治疗后4、8、20周的血iPTH、血钙、血磷、碱性磷酸酶(ALP)等指标,并对不良反应进行监测。结果治疗终点较治疗前血iPTH显著下降(P<0.01),治疗4周达标率为45.1%。治疗中患者血钙无明显上升,血磷较治疗前显著下降,ALP变化无明显差异,不良反应轻微。结论口服活性维生素D冲击治疗继发性甲状旁腺功能亢进疗效显著,安全性良好。尤其是早期冲击治疗更显著。

AIM To observe the therapeutic effect and safety of oral administration with active vitamin D on the pulse treatment of secondary hyperparathyroidism in patients with end stage renal failure. METHODS From April, 2007 to October, 2008, 91 patients with secondmy hyperparathyroidism caused by end stage renal failure were enrolled in the study. The calcium concentration in dialysate was 1.5 mmol·L^-1, and the patients received oral administration of active vitamin D. The end-point parameter was igPTH≤300ng·L^-1 or duration of treatment lasted for 20 weeks. The dose of active vitamin D was 1 - 1.5 μg, twice a week, when the concentration of iPTH varied between 300 and 600 ng·L^-1. The dose of active vitamin D was 1.5 - 2.0 μg, twice a week, when 300 〈 iPTH ≤ 600 ng·L^-1. The dose of active vitamin D was 2.0- 2.5 μg, twice a week, when iPTH〉 1 000 ng·L^-1. The blood concentrations of iPTH, calcium, phosphate and alkaline phosphatase （ALP） before treatment and 4, 8, 20 weeks after treatment were measured, and the adverse drug reactions were monitored. RESULTS Compared with that before treatment, the concentration of iPTH after treatment decreased significantly （ P 〈 0.01 ）, and the percentage of patients reaching end-point parameter at the 4th week accounted for 45.1%. During the course of treatment, the blood concentration of calcium showed no significant increase and the blood concentration of phosphate decreased significantly after treatment. There was no significant difference in alkaline phosphatase concentration and adverse drug reaction was mild. CONCLUSION The therapeutic effects of oral administration with active vitamin D in patients with secondary hyperparathyroidism are found to be remarkable and safe,especially for the early-stage pulse treatment.