摘要
目的:探讨维生素D3和α-骨化醇在降低慢性肾病患者甲状旁腺激素水平的疗效。方法:把79例第3、4期慢性肾病患者随机分为维生素D3组(n=37)和α-骨化醇组(n=42)。两组疗程3个月,具体为维生素D3组(2000IU/日×1个月,1000IU/日×2个月)和α-骨化醇组(0.5μg/日)。结果:在α-骨化醇组,PTH由109±41pg/ml显著降至80±49pg/ml(P=0.006),在维生素D3组变化不明显(113±48pg/ml比95±46pg/ml,P=0.19),然而两组间比较无统计学意义(P=0.21);变异性系数模型分析PTH变化趋势结论同上相似。血清磷、血清钙和尿钙排泄亦无显著性差异。其他指标(血压、尿蛋白)变化无统计学意义,尽管有下降趋势。结论:α-骨化醇显著降低PTH水平,组间差异未见显著性。需要进一步长疗程大样本量的研究。
Objective：To explore the effect of cholecalciferol and α-calciferol in treating of secondary hyperparathyroidism in CKD.Methods：We conducted a randomized,blinded,3-month trial in vitamin D-deficient CKD stage 3 and 4 patients with hyperparathyroidism,comparing cholecalciferol（4000IU/d×1month,then 2000IU/d;n=37）to α-calciferol（0.5g/d;n=42）.Results：There was no difference in baseline demographics or lab tests.The PTH decreased in the α-calciferol group（109±41 to 80±49pg/ml,P=0.006）and decreased in the cholecalciferol group（113±48 to 95±46 pg/ml,P=0.19）,but the difference between treatments was NS（P=0.21）.Similar results were found when absolute PTH change from baseline to end point was analyzed in a repeated-measures ANOVA model.The serum calcium and urine calcium excretions were not different.Additional nonmineral-related end points,albuminuria,and BP were evaluated,and although trends were present,this did not reach significance.Conclusions：This prospective,randomized trial demonstrated a within-group reduction in PTH in the α-calciferol patients but no significant difference between the α-calciferol and cholecalciferol patients.Larger,long-term studies are needed.
