骨化三醇治疗维持性血液透析患者甲状旁腺功能亢进的临床疗效

Efficacy of intravenous and oral pulse therapies of Calcitriol on secondary hyperparathyroidism in maintenance hemodialysis patients

目的探讨骨化三醇注射液和口服制剂冲击治疗维持性血液透析(MHD)患者继发甲状旁腺功能亢进(SHPT)的疗效及安全性。方法收集安徽医科大学第二附属医院MHD并SHPT且不伴有高血钙、高血磷的患者40例,随机分为骨化三醇静脉治疗组(A组)和口服冲击组(B组),疗程12周。分别于治疗前、治疗后4、8和12周测定两组血清全段甲状旁腺激素(i PTH)、碱性磷酸酶(AKP)、钙、磷水平,观察症状改善及不良反应。结果 (1)与治疗前相比,治疗4周后,两组i PTH水平均明显降低(P<0.05);两组在治疗后AKP均有下降趋势,12周后,均出现明显下降(P<0.05)。(2)与B组比较,治疗第8周,A组i PTH水平降低更为显著,并在后续的治疗中维持低于B组水平,差异有统计学意义(P<0.05)。(3)血钙变化:两组在治疗后均有血钙升高趋势,B组血钙改变明显,差异有统计学意义(P<0.05)。(4)血磷水平治疗前后两组差异均无统计学意义。(5)两组临床症状如骨痛、不宁腿、皮肤瘙痒和贫血等均有不同程度改善,其中A组瘙痒改善显著(P<0.05)。结论骨化三醇口服和静脉冲击治疗均能有效降低MHD并SHPT患者的PTH和AKP,改善骨痛及瘙痒等症状。高钙血症是其主要的副作用。与口服冲击治疗比较,静脉注射骨化三醇疗效更为迅速及显著,较少引起高钙血症,MHD患者使用安全方便,透析结束时给药依从性较好。

Objective To discuss the efficacy and safety of Calcitriol injection and oral pulse therapies in maintenance hemodialysis （MHD） patients with secondary hyperparathyroidism （SHPT）. Methods Forty hemodialysis patients with SHPT but without hypercalcemia or hyperphosphatemia were randomly assigned into intravenous Calcitriol group （group A） and oral Calcitriol pulse group （group B）, and accepted treatment for 12 weeks. Serum iPTH, alkaline phosphatase （AKP）, calcium and phosphorus of the two groups were monitored before treatment and 4, 8 and 12 weeks after treatment. The side effects and symptom improvement were also recorded. Results After 4 weeks of treatment, serum iPTH level was significantly reduced in both groups （P〈 0.05）. After 12 weeks of treatment, the AKP level decreased significantly in both groups （P〈 0.05）. After 8 weeks of treatment, serum iPTH of the group A decreased significantly compared to the group B, the difference was still significant until the end of treatment （P〈 0.05）. Serum calcium tended to increase in the later treatment in both groups, the group B had significant changes in serum calcium （P〈 0.05）. There was no significant difference in serum phosphorus before and after treatment in the two groups. Clinical symptoms such as osteodynia, restless legs, pruritus and anemia were improved to various degrees in both groups, while more significant improvement in pruritus was observed in the group A （P〈 0.05）. Conclusions Oral pulse and intravenous Calcitriol therapies can effectively decrease the levels of iPTH and AKP in chronic hemodialysis patients with secondary hyperparathyroidism, and relieve osteodynia and pruritus. Hypercalcemia is the main side effect. Intravenous Calcitriol has more rapid and significant effect compared with oral pulse therapy, rarely causes hypercalcemia, has better compliance at the end of hemodialysis, and is safe and convenient for maintenance hemodialysis patients.