手术与拟钙剂治疗难治性SHPT的短期疗效比较

Comparison of short term curative effects between operation and oral cinacalcet for treating refractory secondary hyperparathyroidism

目的探讨甲状旁腺全切术(t-PTX)与拟钙剂治疗难治性继发性甲状旁腺功能亢进(SHPT)的短期疗效。方法对2012年1月至2015年9月该院收治的118例难治性SHPT患者的临床资料进行回顾性分析,根据治疗方法不同将118例患者分为A(行冲击治疗效果不佳后常规内科治疗,n=62)、B(行t-PTX治疗,n=26)、C(口服拟钙剂治疗,n=30)3组,所有患者均进行常规内科治疗。3组患者均完成第0、1天及1、3、6个月的钙、磷、钙磷乘积、甲状旁腺激素(iPTH)随访。结果 3组患者性别、年龄、透析时间和第0天钙、磷、钙磷乘积及iPTH水平比较,差异均无统计学意义(P>0.05)。A、B、C 3组患者疼痛缓解率分别为0、92.31%、60.00%;与A组比较,B、C组磷、钙磷乘积、iPTH在处理后各时点均明显降低(P<0.01);与C组比较,B组的钙、磷、钙磷乘积、iPTH在处理后各时点均明显减少(P<0.05)。结论对于难治性SHPT能耐受外科手术的患者应首选t-PTX治疗;而口服拟钙剂治疗为难治性SHPT患者提供了非手术治疗的可能。

Objective To study the short-term curative effect of total parathyroidectomy（t-PTX）and cinacalcet therapy for treating refractory secondary hyperparathyroidism（SHPT）.Methods The clinical data of 118 patients with refractory SHPT admitted in our hospital from January 2012 to September 2015 were retrospectively analyzed,and according to different therapeutic methods the patients were divided into the group A（receiving the conventional medical treatment after poor effect by the impact therapy,n=62）,B（performing t-PTX,n=26）and C（oral cinacalcet,n=30）.All patients were given the conventional medical treatment.The calcium,phosphorus and calcium-phosphorus product,and parathyroid hormone（iPTH）follow-up on 0,1d,and at1,3,6months was finished in 3groups.Results The gender,age,dialysis time,calcium,phosphorus,calcium-phosphorus product and iPTH level on 1dhad no statistically significant difference among 3groups（P〉0.05）.the pain relief rates of the group A,B and C were 0,92.31%and 60.00%respectively;compared with the group A,phosphorus,calcium-phosphorus product and iPTH at various time points after processing in the group B and C were significantly decreased（P〈0.01）;compared with the group C,calcium,phosphorus,calcium-phosphorus product and iPTH at various time points after processing in the group B were significantly reduced（P〈0.05）.Conclusion If the patients with refractory SHPT are tolerable for surgery,t-PTX therapy should be taken as the first choice;oral cinacalcet treatment provides the possibility of non-operative therapy for the patients with refractory SHPT.