活性维生素D_3治疗对维持性血透患者左心室肥厚的影响

Effect of 1.25-dihydroxyvitamin D_3 Treatment on the left Ventricular Hypertrophy in Maintenance Hemodialysis Patients

目的 :研究活性维生素D3 制剂罗钙全治疗对维持性血透 (MHD)患者左心室肥厚 (LVH)的影响。方法 :伴继发性甲状旁腺功能亢进的MHD患者 30例随机分成两组 ,治疗组 16例接受罗钙全治疗 (口服 ,2 μg/次 ,2～ 3次 /周 )共 12周 ,余 14例作为对照组。其它治疗两组均相同。期间观察血甲状旁腺素 (iPTH)水平及左室舒张末期内径 (LVDd)、左室收缩末期内径 (LVDs)、左房内径 (LAD)、室间隔厚度 (IVST)和左室后壁厚度 (PWT)变化。结果 :(1)治疗前两组血iPTH水平明显高于正常 ,存在继发性甲状旁腺功能亢进 ,但两组间无差异 :两组间LVDd、LVDs、LAD、IVST、PWT值均无差异 ,但均明显高于正常值或处于正常值高限 ;(2 )治疗组 12周后血iPTH水平和LVDd、LVDs、LAD、IVST、PWT值均较治疗前明显降低 ,而对照组 12周后上述参数均无明显改变。结论 :活性维生素D3 治疗可明显改善维持性血透患者的左心室肥厚 ,此作用与其改变继发性甲状旁腺功能亢进有关。

Objective:To evaluate the effect of 1.25-dihydroxyvitamin D 3 treatment on the left ventricular hypertrophy(LVH) in maintenance hemodialysis(MHD) patients.Methods:Of thirty MHD patients with secondary hyperparathyroidism(serum intact parathyroid hormone level>200 ng/L),sixteen were treated with 1.25-dihydroxyvitamin D 3 in dose of 2 μg every time,2～3 times weekly for 12 weeks,and the others were served as the control.Before and after the treatment,the serum intact parathyroid hormone(iPTH)levels were measured and all parameters of LVH,including left ventricular end diastolic diameter(LVDd),left ventricular end systolic diameter(LVDs),left atrial diameter(LAD),inter-ventricular septum thickness(IVST) and left ventricular posterior wall thickness(PWT) were examined using echocardiography.Results:(1)Before the treatment,serum iPTH levels and all parameters of LVH in all the patients were significantly higher than normal,but there was no difference between the treated and the control group;(2)After the treatment,serum iPTH levels decreased significantly and all the parameters of LVH were improved significantly in the treated group,but these changes did not take place in the control group.Conclusions:The 1.25-dihydroxyvitamin D 3 treatment can improve LVH significantly in MHD patients,and it may be due to the improvement of secondary hyperparathyroidism.