骨化三醇治疗慢性肾功能衰竭患者继发甲状旁腺功能亢进的临床观察

Clinical Observation of Calcitriol for the Treatment of Secondary Hyperparathyroidism in Patients with Chronic Renal Failure

目的:评价骨化三醇常规治疗和冲击治疗对慢性肾功能衰竭患者继发甲状旁腺功能亢进(SHPT)的疗效。方法:选择肾功能不全82例血液透析患者,血甲状旁腺激素(iPTH)水平>300pg/mL,随机分为冲击组和常规治疗组,结合临床服用不同剂量的骨化三醇,观察24周,检测治疗前后血iPTH及钙磷代谢相关指标。结果:与治疗前相比,冲击组、常规治疗组的钙,iPTH,ALP(碱性磷酸酶)的值与之前有明显差异(P<0.05);与治疗前相比,常规治疗组及冲击组治疗血磷均有所下降,无统计学差异。冲击治疗组与常规治疗组比较,在4周、8周、12周,两组间的iPTH有明显的统计学差异(P<0.05),24周时两组间iPTH无明显的统计学差异。两组的不良反应均较少。结论:骨化三醇用于慢性肾功能衰竭患者继发性甲旁亢临床效果安全确切,冲击疗法较常规治疗对降低iPTH的临床疗效更为显著。

Objective： To investigate the efficiency of calcitriol in treatment of secondary hyperparathy- roidism I SHPT} in chronic renal failure patients. Method： 82 cases of chronic renal insufficiency patients with hemodialysis were seleceted { serum parathyroid hormone levels 〉 300 pg / mL）, and were randomly di- vided into pulse group and routine treatment group. The dosage of calcitriol was combined with the clinical situation. Patiens were observed for 24 weeks, iPTH in blood and calcium and phosphorus metabolism related indexes were measured. Result： There was significant differences between values of alcium, iPTH,and ALP before and after treatment in two groups （ P 〈0.05 ）. There was no significant difference between values of serum phosphorus before treatment and after in two groups. But the value of serum phosphorus was decresed. There was significant differences of the iPTH value between two groups after treatment for 4 weeks, 8 weeks, and 12 weeks（ P 〈0.05 ） ,and there was no differences after treatment for 24 weeks. There were seldom adverse reactions in two groups. Conclusion： Calcitriol pulse therapywith reasonably adjusted dosage is effective and safe for SHPT. Compared with routine treatment, the clinical curative effect of pulse therapy on reducing iPTH level is more notable.