阿法骨化醇和骨化三醇冲击治疗对血液透析患者继发性甲状旁腺功能亢进的疗效分析

An analysis of the efficacy of pulse administration of alfacalcidol and calcitriol in the treatment of secondary hyperparathyroidism in hemodialysis patients

目的比较阿法骨化醇和骨化三醇口服冲击治疗对维持性血液透析患者继发性甲状旁腺功能亢进（SHPT）的疗效及对血钙、血磷水平的影响。方法选取37例血全段甲状旁腺激素（iPTH）水平300～500ng／L的维持性血液透析患者，随机分为阿法骨化醇冲击治疗组（阿法骨化醇组，n=19）和骨化三醇冲击治疗组（骨化三醇组，n：18），观察时间12周，观察终点为iPTH水平〈150—300ng／L。分别检测治疗前和治疗后4、8、12周血iPTH及钙、磷水平。结果在治疗后第12周，阿法骨化醇组和骨化三醇组iPTH水平均较治疗前显著降低（P〈0．01），2组的治疗达标率差异无统计学意义（P〉0．05）。治疗后2组的血钙水平均较治疗前升高（P〈0．05或P〈0．01），2组之间血钙水平差异无统计学意义（P〉0．05）。治疗后12周骨化三醇组血磷水平较治疗前升高（P〈0．05），阿法骨化醇组治疗前后差异无统计学意义（P〉0．05），2组之间的比较差异无统计学意义（P〉0．05）。结论阿法骨化醇和骨化三醇口服冲击均对血液透析患者SHPT有显著疗效，二者对血清钙、磷的影响无显著差异。

Objective To compare the efficacy of pulse administration of alfacalcidol and ealcitriol in the treatment of secondary hyperparathyroidism （SHPT） in maintenance hemodialysis patients, and tile effects on the levels of serum calcium and phosphorus. Methods A total of 37 maintenance hemodialysis patients with the serum parathyroid hormone （iPTH） levels of 300 -500 ng/L were enrolled. They were randomly divided into an alfacalcidol treatment group and a calcitriol treatment group. The observation time was 12 weeks, which was stopped when the level of iPTtt was less than 150 -300 ng/L. Then, the levels of serum iPTH, calcium and phosphorus levels were measured before and 4, 8 and 12 weeks after treatment. Results Compared with those before treatment, the iPTH levels were remarkable reduced in both the alfacalcidol group （ P 〈 0.01 ） and the calcitriol group （ P 〈 0.01 ） on Week 12 after treatment. But, there was no significant difference in iPTH level between the two groups （ P 〉 0.05 ）. After treatment, both groups presented markedly higher levels of serum calcium than those before treatment （P 〈0.05 or P 〈0.01 ）, but there was no significant differ- ence in the level of serum calcium between the two groups （P 〉 0.05 ）. Compared with those before treatment, the a- mount of serum phosphorus was remarkably increased in the calcitriol group 12 weeks after treatment （P 〈 0.05 ）. However, no statistical significance was found as to the amount of serum phosphorus in the alfacalcidol treatment group before and after treatment （ P 〉 0.05 ）. Conclusions Pulse administration of alfacalcidol and calcitriol is significantly effective on SHPT in hemodialysis patients. There is no significant difference in the levels of serum calcium and phosphorus between the two groups.