继发性甲状旁腺功能亢进的治疗现状

Treatment status in patients with secondary hyperparathyroidism

继发性甲状旁腺功能亢进（SHPT）是慢性肾脏病的重要并发症，可致骨骼病变，增加软组织和血管钙化的风险，是心血管事件与死亡的重要预测因子。近年来成纤维细胞生长因子-23（FGF-23）及钙敏感受体（CaSR）的发现为揭示继发性甲状旁腺功能亢进发病机制提供了依据；美国基金会制定的肾脏疾病患者生存质量指南（K/DOQI）及改善全球肾脏病预后组织（KDIGO）有关慢性肾脏病-矿物质和骨异常（CKD-MBD）指南的颁布为继发性甲状旁腺功能亢进提供了治疗目标；新型磷结合剂、维生素D类似物以及钙敏感受体激动剂等药物治疗以及透析模式、手术方法的不断推新和改进在不同程度上降低了CKD3~5期患者的甲状旁腺素（PTH）水平，推进了SHPT的治疗。本文就继发性甲状旁腺功能亢进的治疗现状做一介绍。

Secondary hyperparathyroidism （SHPT） is an important complication of chronic kidney disease （CKD）, which contributes to the skeleton changes, increases the risk of soft tissue and vascular calcifications, and becomes an important predictor of cardiovascular events and mortality. The discovery of fibroblast growth factor-23 and calcium-sensing receptors offered basis for revealing pathogenesis of SHPT.Kidney Disease Outcomes Quality Initiative （K/DOQI） and Kidney Disease Improving Global Outcomes （KDIGO） published the guidelines for mineral and bone disorder of chronic kidney disease, which provided the therapeutic goal for SHPT. Not only the development of new phosphate binders, vitamin D analogues and calcium-sensing receptors agonists, but also the improvement of dialysis patterns and surgical methods, can reduce the PTH level of CKD stages 3 - 5 patients. This review focuses on the treatment status of secondary hyperparathyroidism.