骨化三醇联合长时血液透析对维持性血液透析继发性甲状旁腺功能亢进患者的影响

Influence of the therapy of calcitriol combined with prolonged hemodialysis on refractory secondary hyperparathyroidism in maintenance hemodialysis patients

目的探讨骨化三醇联合长时血液透析对维持性血液透析继发性甲状旁腺功能亢进患者血甲状旁腺激素（PTH）、钙、磷水平的影响。方法将22例维持性血液透析继发性甲状旁腺功能亢进患者进行长时血液透析治疗，3次／周，每次6h。同时口服骨化三醇1I,zg／次，3次／周，共治疗3个月。分别于治疗前和治疗后检测血PTH、钙及磷水平。结果患者治疗后血PTH和血磷较治疗前明显下降[（484．21±230．18）nmol／L比（750．53±327．41）nmol／L、（1．49±0．27）mmol/L比（2．37±0．76）mmol／L]，血钙较治疗前明显上升[（2．35±0．32）mmol／L比（1．81±0．53）mmol／L]，差异均有统计学意义（P〈0．05）。结论骨化三醇联合长时血液透析可以降低维持性血液透析继发性甲状旁腺功能亢进患者血磷及血PTH，升高血钙，对治疗维持性血液透析继发性甲状旁腺功能亢进有一定的疗效。

Objective To observe the influence of calcitriol combined with prolonged hemodialysis on parathyroid hormone （PTH）, phosphorus and calcium in maintenance hemodialysis patients with refractory secondary hyperparathyroidism. Methods Twenty-two maintenance hemodialysis patients received prolonged hemodialysis （3 times per week and 6 hours each session） and therapy with calcitriol（3 times per week and 1 μ g each time） for 3 months. The levels of serum PTH, calcium and phosphorus of these patients were recorded before and after treatment. Results Compared with that before treatment,the level of serum PTH and phosphorus was decreased significantly[ （484.21 ± 230.18） nmol/L vs. （750.53± 327.41 ）nmol/L, （1.49 ±0.27） mmol/L vs. （2.37 ±0.76） mmol/L],but calcium was increased after treatment [（2.35 ±0.32） mmol]L vs. （1.81± 0.53） mmol/L], and there was significant difference （P 〈0.05）. Conclusions The treatment of calcitriol combined with prolonged hemodialysis not only effectively clear phosphorus and PTH but also increase calcium in maintenance hemodialysis patients. The therapeutic schedule is good to maintenance hemodialysis patients with refractory secondary hyperparathyroidism.