同等剂量不同方法1,25(OH)_2D_3对血透患者继发性甲旁亢的影响

EFFECTS OF INTERMITTENT INTRAVENOUS OR ORAL DAILY 1,25(OH)_2D_3 WERE GIVEN BY SAME DOSE IN HEMODIALYSIS PATIENTS WITH SECONDARY HYPERPARATHYRODISM

目的 比较同等剂量 1,2 5 (OH) 2 D3 间断静脉注射与持续口服两种治疗方法对继发性甲旁亢 (secondaryhy perparathroidism ,SHPT)患者的疗效。方法 30例血清甲状旁腺激素全段 (Intactparathyroidhormone,iPTH) >2 0pmol/L的维持性血液透析 (maintenancehemodialysis ,MHD)患者 ,随机分为间断静脉注射组 (A组 )及持续口服治疗组 (B组 )。观察血液透析 (HD)前、后及下一次HD前的iPTH含量和 1,2 5 (OH) 2 D3 治疗前及治疗后 4、8、12、2 4周的iPTH、血清钙 (SCa)、磷 (SP)、碱性磷酸酶 (AKP)的变化 ,疗程 2 4周。结果 两次HD前iPTH、SCa、SP水平无明显差异。与治疗前相比 ,A组 12、2 4周后iPTH水平显著降低 ,SCa显著升高 ,2 4周后AKP显著降低 ;B组治疗前后上述指标均无明显变化。结论 常规HD不能有效地控制SHPT ,同等剂量的 1,2 5 (OH) 2 D3 间断静脉注射治疗对MHD患者SHPT的疗效优于持续口服疗法。

Objective\ To compare the effects of same dose administration of 1,25(OH) 2D 3 in secondary hyperparathyroidism (SHPT) in maintenance hemodialysis (MHD) patients.The 1,25(OH) 2D 3 were given by intermittent intravenous injection or oral daily.Method\ 30 hemodialysis (HD) patients with eleveted intact parathyroid hormone (iPTH>20 pmol/L) were randomly allocated to intermittent intravenous injection (group A)or routine oral daily (group B).The level of iPTH was measured before HD,after HD and between two HD.Serum concentration of Ca、P、AKP、iPTH were compared before,1,25(OH) 2D 3 treatment and after administration 4、8、12、24 weeks respectively.The observing time was 24 weeks.Results\ There was no significant difference between two prehemodialysis specimens in iPTH、Serum Ca\,P.There were significant reductions of iPTH after 12\,24 weeks,AKP after 24 weeks,significant increment of serum Ca after 12 and 24 weeks in group A respectively.No significant changes of above parameters were seen in group B.Conclusion\ SHPT can not be controlled effectively by routine HD.For same dose administration of 1,25(OH) 2D 3 intermittent intravenous injection possesses a better effect than daily oral in improving SHPT of MHD patients.