骨化三醇冲击治疗维持血液透析继发甲状旁腺功能亢进患者的临床观察

Clinical Effect of Calcitriol Pulse Therapy in Hemodialysis Patients with Secondary Hyperparathyroidism

目的：比较骨化三醇常规口服与冲击疗法治疗维持血液透析继发甲状旁腺功能亢进（简称继发性甲旁亢）的临床疗效。方法选取2011年2月-2013年4月本院收治的100例继发甲旁亢的维持性血液透析患者，将其按照全段甲状旁腺素（ iPTH）水平分为两组（ iPTH 300-500ng/L组和iPTH﹥500 ng/L组），各组再随机分成对照组（每晚睡前口服骨化三醇0.5μg）与观察组（夜间睡前口服骨化三醇2μg/次，2次/周）。观察治疗前后的血iPTH、钙及磷水平。结果治疗12周后，iPTH 300-500ng/L组中，观察组和对照组iPTH、矫正钙、磷及钙磷乘积比较，差异均无统计学意义（ P﹥0.05）。治疗12周后，两组矫正钙、钙磷乘积均上升，iPTH均下降，差异有统计学意义（ P﹤0.05）。iPTH﹥500ng/L组中，观察组和对照组iPTH、矫正钙、磷及钙磷乘积比较，差异均无统计学意义（ P﹥0.05）。治疗12周后，观察组矫正钙、钙磷乘积均上升，iPTH下降，差异有统计学意义（ P﹤0.05）。而对照组矫正钙、磷、钙磷乘积以及iPTH与治疗前比较，差异无统计学意义（ P﹥0.05）。结论对于继发中度继发性甲状旁腺功能亢进症的维持性血透患者，骨化三醇冲击治疗优于常规治疗。

Objective To compare the efficacy of calcitriol routine and pulse therapy in the treatment of hemodialysis patients with secondary hyperparathyroidism. Methods 100 hemodialysis patients with secondary hyperparathyroidism in our hospital from February 2011 to April 2013,were devided into group iPTH in 300-500ng/L（n=55）and group iPTH﹥500 ng/L（n=45）,each group was randomly devided into control group（oral calcitriol 0. 5μg,once a day）and observation group（ oral calcitriol 2μg,twice a week）. The levels of serum iPTH,calcium and phosphorus before and after treatment were observed. Results After 12 weeks of treatment,iPTH in 300 -500ng/L group,iPTH,calcium,phosphorus and calcium phosphorus product of observation group and the control group were not significantly different（P﹥0. 05）. After 12 weeks of treatment,those two groups of calcium,calcium phosphorus product were increased,iPTH was decreased,the difference were statistically significant（P﹤0. 05）. iPTH﹥500ng/L group,iPTH,calcium,phosphorus and calcium phosphorus product of observation group and control group were not significantly different（ P﹥0. 05）. After 12 weeks of treatment,calcium,calcium phosphorus product of observation group were increased,iPTH decreased,the difference were statistically significant（ P ﹤0. 05）. While serum calcium,phosphorus,calcium phosphorus product and iPTH of observation group compared with before treatment were not significantly different（P﹥0. 05）. Conclusion Calcirtiol pulse therapy in hemodialysis patients with moderate secondary hyperparathyroidism was more valuable than routine therapy.