骨化三醇治疗对血液透析患者矿物质、骨代谢紊乱及FGF23的影响

The Impact of Calcitriol Treatment on Hemodialysis Patients with CKD-MBD and on the Concentration of FGF23

目的：评价骨化三醇不同给药方案对血液透析患者矿物质及骨代谢紊乱（CKD-MBD）及FGF23的影响。方法：选取血甲状旁腺素（PTH）水平在300~621 pg/ml（正常的4~9倍）之间的血液透析患者,随机分成骨化三醇常规治疗组（常规组,22例）和间歇给药组（间歇组,26例）,疗程16周,检测治疗前后血清FGF-23水平、钙磷代谢等指标变化。结果：（1）两组患者治疗终点与治疗前比较,血PTH均明显下降、血维生素D及FGF23均明显升高（P〈0.05）。间歇组在治疗终点,血钙明显升高、碱性磷酸酶明显下降（P〈0.05）,而持续组,治疗前后血钙、碱性磷酸酶无明显变化。（2）在不同治疗时间点,持续组PTH明显下降（P〈0.05）;间歇组PTH、碱性磷酸酶明显下降,血钙明显升高（P〈0.05）。治疗第4周、第8周,间歇组PTH下降较持续组明显（P〈0.05）。（3）治疗期间,持续组有6例患者血磷升高,间歇组无血磷升高患者。治疗期间无高钙血症发生。结论：骨化三醇不同给药方案能不同程度下降患者血PTH、升高FGF23,间歇组较持续组明显;间歇给药组血钙明显升高、碱性磷酸酶明显下降。两组治疗方案均能改善继发性甲状旁腺功能亢进,间歇给药组降PTH效果更佳。骨化三醇治疗轻中度继发性甲状旁腺功能亢进安全有效。

Objective： To study the impact of calcitriol treatment on maintenance hemodialysis patients with chronic kidney disease- Mineral and bone disorder（ CKD- MBD） and plasma fibroblast growth factor 23（ FGF23） concentration of those patients.Methods： A total of 48 maintenance hemodialysis patients with CKD- MBD and secondary hyperparathyroidism were enrolled in the study,whose serum parathyroid hormone（ PTH） level was in 300 ~ 621 pg / ml（ 4 ~ 9 times normal）. All patients were randomly divided into two groups： calcitriol treatment for everyday（ routine treatment group,22 cases） and pulse intermittent administration group（ intermittent group,26 cases）,16 weeks of treatment. Serum FGF- 23 levels、calcium and phosphorus metabolism index were detected before and after treatment. Results：（ 1） The i PTH levels in two groups were all significantly decreased after therapy,but the FGF23 levels and Vit D levels were significantly increased（ P〈0. 05）. At the end of treatment,the serum calcium levels of the intermittent group significantly increased and alkaline phosphatase levels of those significantly decreased（ P〈0. 05）,whereas the levels of serum calciumand and alkaline phosphatase had no obvious change in routine treatment group.（ 2） In the different treatment time,PTH leves of routine treatment group decreased obviously（ P〈0. 05）; In the intermittent group,the PTH,alkaline phosphatase leves decreased obviously,and blood calcium leves significantly increased（ P〈0. 05）. Treatment of 4 weeks,8 weeks,intermittent gruop of PTH significantly decreased than routine group significantly（ P〈0. 05）.（ 3） Six patients during treatment had elevated of blood phosphorus levels and there is no hyperphosphatemia in intermittent group. Hypercalcemia was not occurred during the treatment.Conclusion： Calcitriol treatment in patients with different dosage can decrease blood PTH,elevated FGF23. Intermittent group compared with routine group was more obvious; Intermittent group increase blood calcium and alkaline phosphatase decreased more obviously. Two groups of treatment all can improve the secondary hyperparathyroidism,Intermittent group drop PTH effect is better. Calcitriol treatment mild- to- moderate secondary hyperparathyroidism is safe and effective.