骨化三醇冲击治疗对维持性血液透析患者微炎症及动脉粥样硬化的影响

目的探讨骨化三醇冲击治疗对维持性血液透析(MHD)患者微炎症及动脉粥样硬化的影响。方法 36例MHD患者按照其血甲状旁腺激素水平的高低分为A、B两组,骨化三醇使用方法:A组(n=18):罗钙全0.25μg,Qd;B组(n=18):罗钙全2.0μg,2次/周,均为透析后当晚口服,观察16周,另设10名健康查体人员作为对照组,静脉采血查甲状旁腺激素(PTH)、钙(Ca)、磷(P)、超敏-C反应蛋白(hs-CRP),超声检测颈动脉内膜厚度。结果治疗前A组患者IMT为(0.9±0.3)mm,B组患者IMT为(1.3±0.2)mm,均高于对照组(P<0.01);治疗后,A组患者IMT为(1.2±0.2)mm,B组患者IMT为(1.2±0.3)mm,A组IMT较同组治疗前显著增加(P<0.05),而B组的IMT较治疗前没有增加。治疗前A组患者血hs-CRP为(4.2±0.5)mg/L,B组患者血hs-CRP为(4.3±0.6)mg/L,皆高于对照组(P<0.01),治疗后B组较同组治疗前有显著降低(P<0.05);相关分析表明,hs-CRP与IMT成正相关(r=0.35,P<0.05)。结论骨化三醇冲击治疗可以延缓MHD患者的动脉粥样硬化进展,可能与其降低患者炎症介质的表达有关。

Objective To study the effects of high dose pulse oral calcitrol on microinflammatory and atherosclerosis in maintenance hemodialysis patients. Methods 36 maintenance hemodialysis patients with secondary hyperparathyroidism received conventional calcitriol therapy （groupA, n=18, calcitriol 0.25 μ g, Qd） and high dose pulse oral calcitriol therapy （group B, n=18, calcitriol 2.0 μg, twice a week） for 16 weeks, and 10 normal subjects were served as control group. They were examined with biochemistry tests, hs-CRP, PTH and carotid color doppler ultrasonography. Results Both A and B group patients had significantly higher IMT than those of control group before treatment （P〈0.01）. After 16 weeks treatment, IMT in group A was significantly increased compared with before treatment （P〈0.05） while in the group B was not significantly changed. The blood hs-CRP in both A and B group patients were significantly higher than those in control group before treatment （P〈0.01）, while after treatment is significantly reduction in group B （P〈0.05）. Related analysis shows that, hs-CRP was positively correlated with IMT （r=0.35, P〈0.05）. Conclusion High dose pulse oral calcitrol therapy can reduce the microinftamrnatory level which may result in the delay of progress of atherosclerosis in MHD patients.