腹膜透析患者继发性甲状旁腺功能亢进的诊治

Management of secondary hyperparathyroidism in peritoneal dialysis patients

继发性甲状旁腺功能亢进(SHPT)是慢性肾脏病的常见并发症,与钙磷代谢紊乱共同参与透析患者的骨骼代谢、心血管及软组织钙化,严重降低了透析患者的生活质量,增加其死亡率。其中影响维持性腹膜透析患者钙、磷、甲状旁腺激素(PTH)代谢的因素诸多,包括饮食、残余肾功能、腹膜的转运特性、透析液的钙离子浓度、磷结合剂的应用。早期诊断及合理治疗是延缓此类并发症的重要手段。临床工作中针对腹膜透析患者合并SHPT的治疗主要包括药物疗法及甲状旁腺切除术。目前国内应用的药物主要包括活性维生素D、钙剂、拟钙剂,新型钙敏感受体激动剂AMG-416已经显示出较好的临床疗效。甲状旁腺切除术主要应用于难治性SHPT患者,主要包括甲状旁腺次全切除术和甲状旁腺全切加自体移植术。

Secondary hyperparathyroidism（ SHPT） is a common complication of chronic kidney disease. And along with calcium and phosphorus metabolic disorders,SHPT play a serious impact on bone metabolism,cardiovascular and soft tissue calcification in dialysis patients,reducing the patients＇ life quality,and increasing the mortality. For continuous ambulatory peritoneal dialysis（ CAPD） patients,there are various factors influencing calcium,phosphorus,and PTH metabolism,including diet,residual renal function,peritoneal transport characteristics,dialysate calcium concentration,and phosphate-binding drugs.Early diagnosis and appropriate treatment are still important measurers to delay these complications. The main treatment for SHPT includes medicine and parathyroidectomy. At present in our country,activated vitamin D,calcium agent,cinacalet,and AMG 416,a novel peptide agonist for the calcium-sensing receptor,have manifested better clinical efficacy. Parathyroidectomy has been mainly used for treating refractory SHPT,including subtotal parathyroidectomy and total parathyroidectomy plus autotransplantation.