骨化三醇冲击治疗对血液透析继发性甲旁亢患者疗效的影响

A Study of Curative Effect of Calcitriol Pulse Therapy on Hemodialysis Secondary Hyperpara-thyroidism

【目的】研究骨化三醇冲击治疗对血液透析继发性甲状旁腺功能亢进（甲旁亢）患者甲状旁腺激素（PTH）、血钙与血磷水平的影响。【方法】将90例血液透析继发性甲旁亢患者纳入研究对象，采用随机数字表法分为观察组和对照组，每组各45例，观察组接受骨化三醇冲击剂量治疗、对照组接受骨化三醇常规剂量治疗，比较两组患者PTH、血钙与血磷水平，骨代谢指标及不良反应。【结果】①治疗后4周、8周、12周时，观察组PTH水平明显低于对照组（405．62±50．62VS514．74±61148，335．93±45．96vs441．38±56．23，241．87±39．43 vs 352．58±49．62）pg／mL，且两组相比较差异均有显著性（P〈0．05）；②观察组患者的血钙水平明显高于对照组（2．49±0．35 vs 2．21±0．25）mmol／L，血磷水平均明显低于对照组（1．21±0．16 vs 1．78±0．24）mmol／L；③观察组患者的血清骨碱性磷酸酶（BALP）、骨钙素（Oc）含量均明显低于对照组[（24．59±4．95 vs 50．66±6．78）U／L，（4．49±0．62 vs 8．87±0．94）μg／L]，且两组相比较差异均有显著性（P〈0．05）；④观察组不良反应为2．22％，明显低于对照组17．78％，且两组相比较差异均有显著性（χ2=6．049，P〈0．05）。【结论】骨化三醇冲击治疗有助于降低PTH水平，调节血钙和血磷平衡，改善患者骨代谢，降低不良反应，提高治疗效果。

[Objective]To study the effect of calcitriol pulse therapy on hemodialysis secondary hyperpara- thyroidism and their levels of parathyroid hormone , serum calcium and serum phosphorus. [Methods] 90 ca- ses of patients with hemodialysis secondary hyperparathyroidism in our hospital were enrolled and randomly divided into two grups,the observation group and the control group, 45 cases for each them. The observation group received calcitriol pulse dosage therapy, while control group received conventional calcitriol dosage ther- apy . The results of parathyroid hormone , serum calcium and serum phosphorus , bone metabolic index and advervse reactions were compared. [Results]①parathyroid hormone：4, 8, 12 weeks after treatment, parathy- roid hormone levels of the observation group were lower than those of the control group （405.62 ±50.62 vs 514.74±61.48, 335.93±45.96 vs 441.38±56.23, 241.87±39.43 vs 352.58±49.62）pg/mL;②serum calcium and serum phosphorus., serum calcium level of the observation group was higher than that of the control group （2.49 ± 0.35 vs 2.21 ± 0.25） retool/L, and serum phosphorus level was even lower than that of the control group （1.21±0.16 vs 1.78±0.24） mmol/L;③bone metabolism index., serum BALP and OC contents of the observation group were lower than those of the control group [ （24.59 52 4.95 vs 50.66 52 6.78） U/L, （4.49 ± 0.62 vs 8 875±0.94） μg/L] ,the difference hereby was significant （ P 〈0.05） ④Adverse reactions： the obser- vation group was 2.22 %, significantly lower than the control group 17.78 %, the difference hereby was signifi- cant（χ2=6.049, P 〈0.05）. [Conclusions]Caicitriol pulse therapy is helpful to reduce PTH level, regulate cal- cium and phosphorus balance, improve bone metabolism~ it＇s an ideal method in treating hemodialysis seconda- ry hyperparathyroidism.