低钙透析联合骨化三醇冲击治疗在维持性血液透析患者继发性甲旁亢中的应用

Effect of low calcium dialysate combined with Calcitriol pulse therapy on secondary hyperparathyroidism in maintenance hemodialysis patients

目的观察骨化三醇冲击联合低钙透析治疗不同程度血液透析患者继发性甲旁亢(SHPT)的疗效。方法选择我院42例维持性血液透析患者,按甲状旁腺素(iPTH)水平不同分为三组:A组300pg/ml<iPTH<600pg/ml,B组600pg/ml≤iPTH<1000pg/ml,C组iPTH≥1000pg/ml,分别给予骨化三醇口服～3μg,2次/周;3～4μg,2次/周;4～5μg,2次/周,透析液钙浓度均为1.25mmol/L,治疗过程中,每2周检测一次iPTH、血清钙(SCa)、血清磷(SP)、碱性磷酸酶(ALP)。结果与治疗前比较,A组和B组患者治疗8周后,ALP、iPTH明显下降(P<0.05),SCa、SP变化不大(P>0.05),骨痛、乏力、皮肤瘙痒等症状亦获得全部或部分缓解,C组患者对骨化三醇冲击治疗效果不明显。结论骨化三醇冲击治疗对中度SHPT疗效较显著,起效较快。

Objective To observe the effect of low calcium dialysate combined with calcitriol pulse therapy on secondary hyperparathyroidism （SHPT） in maintenance hemodialysis patients of different degree. Methods For- t-y-two maintenance hemodialysis patients were selected from our hospital and divided into three groups according to their iPTH： group A （300 pg/ml〈iPTH〈600 pg/ml, treated with calcitriol 2-3 μg, two times per week）, group B （600 pg/ml≤iPTH〈1 000 pg/ml, treated with calcitriol 3-4 gg, two times per week） and group C （iPTH≥ 1 000 pg/ ml, treated with calcitriol 4-5 gg, two times per week）. Hemodialysis with low calcium dialysate （1.25 mmol/L） was applied for all the patients. Serum calcium, phosphorus, iPTH, ALP and other side effects were observed. Results In group A and group B, after 8 weeks of treatment, the iPTH and ALP significantly declined （P〈0.05）, the serum calcium and phosphorus showed no significant difference （P〉0.05）, and the symptoms of bone pain, tired feeling, pruritus were completely or partially relieved. There was no significant difference in group C after the therapy with pulse dose calcitriol. Conclusion Low calcium dialysate combined with calcitriol pulse therapy is effective for moderate SHPT.