骨化三醇治疗继发甲状旁腺功能亢进的疗效观察

Effect of calcitriol on secondary hyperparathyroidism

目的:对维持血液透析患者的骨代谢指标进行横断面调查并观察大剂量骨化三醇冲击治疗继发甲状旁腺功能亢进的疗效。方法:检测146例维持血液透析患者的骨代谢指标:血钙、血磷、血碱性磷酸酶(alkaline phosphatase,AKP)及血清全段甲状旁腺素(intact parathyroid hormone,iPTH)。按照透析时间长短将患者分为A组(透析时间≤3年)和B组(透析时间>3年),比较两组的骨代谢指标;根据彩色超声波是否检查出甲状旁腺弥漫性增大或结节将接受骨化三醇冲击治疗的患者分为甲状旁腺异常组(I组)及正常组(II组),2组共20例,并检测冲击治疗前后骨代谢指标的变化。结果:146例维持血液透析患者的血磷为2.00～2.75(2.11±0.38)mmol/L,iPTH为(581.11±487.75)pg/mL;B组血iPTH明显高于A组[(828.13±690.39)pg/mL vs(477.94±324.73)pg/mL,P<0.001];骨化三醇冲击治疗能改善患者的临床症状;II组在冲击疗法后iPTH和AKP较治疗前明显下降[iPTH:(369.3±43.4)pg/mLvs(1358.5±302.8)pg/mL;AKP:(234.8±21.1)U/L vs(565.9±23.9)U/L,P<0.001],I组iPTH和AKP在冲击疗法前后差异无统计学意义(P>0.05);两组患者血钙和血磷在冲击治疗前后变化差异无统计学意义(P>0.05)。结论:骨化三醇冲击治疗能改善维持血液透析患者的矿物质及骨代谢紊乱引起的临床症状,骨化三醇冲击治疗能显著降低甲状旁腺正常患者血iPTH及血AKP浓度。

Objective：To investigate the calcium-phosphate metabolic condition in maintenance hemodialysis patients with chronic kidney disease （CKD）, and to observe the effect of large dose calcitriol on secondary hyperparathyroidism （SHPT）. Methods：We tested and compared the serum levels of calcium, phosphate, intact parathyroid hormone （iPTH）, and alkaline phosphatase （AKP） in hemodialysis patients at different hemodialysis time （Group A with hemodialysis period≤3 years and Group B with hemodialysis period〉3 years）. We also detected those indexes before and after treating SHPT with large dose calcitriol. Twenty SHPT patients were divided into Group I （enlargement of parathyroid gland or nodule detected by color Doppler ultrasound） and Group II （normal parathyroid gland detected by color Doppler ultrasound）. Results：In the maintenance hemodialysis patients, the serum phosphate was （2.11±0.38） mmol/L and iPTH was （581.11±487.75） pg/mL. The serum level of iPTH in Group B was higher than that in Group A [（828.13±690.39） pg/mL vs （477.94±324.73） pg/mL, P〈0.001]. In Group I, the serum level of iPTH [before vs after：（2471.7±898.3） pg/mL vs （2510.4±825.7） pg/mL] and AKP [before vs after：（524.2±18.8）U/L vs （511.3±19.3）U/L] did not change after the treatment of large dose calcitriol （P〉0.05）. In Group II, the serum level of iPTH [before vs after：（1358.5±302.8） pg/mL vs （369.3±43.4） pg/mL, P〈0.001] and AKP [before vs after：（565.9±23.9）U/L vs （234.8±21.1）U/L, P〈0.001] decreased signiifcantly after the treatment of large dose calcitriol. Conclusion：Patients with longer time of hemodialysis have a higher level of iPTH. Large dose calcitriol can improve the clinical syndrome of SHPT, and decrease the level of iPTH and AKP in SHPT patients with normal parathyroid gland.