西那卡塞及碳酸镧联合骨化三醇治疗慢性肾衰竭透析患者继发重度甲状旁腺功能亢进的疗效观察

Clinical effect of cinacalcet combined with large dose calcitriol and lanthanum carbonate on hemodialysis patients with secondary hyperparathyroidism

目的:观察钙敏感受体激动剂西那卡塞和磷结合剂碳酸镧联合骨化三醇治疗慢性肾功能衰竭血液透析患者继发重度甲状旁腺功能亢进症的疗效。方法:选取2016-01~12我院进行规律血液透析尿毒症合并重度继发性甲状旁腺功能亢进症的患者20例,随机分成两组:观察组10例和对照组10例。观察组患者给予西那卡塞片,起始剂量25mg/d,每2周复查一次血钙、血磷、iPTH,根据检测结果逐渐将剂量调整至75mg/d。两组患者均于透析后当晚口服骨化三醇,4~6μg,每周二次;所有患者均有不同程度的高磷血症,给予口服碳酸镧500mg,每日3次。将150pg/m L<iPTH<300pg/m L认定为达标。所有患者观察治疗前及治疗后1,2,3,6个月血清钙,磷,iPTH,计算钙磷乘积,进行比较。结果:治疗后观察组血iPTH水平明显低于对照组,差异有统计学意义(P<0.05);两组患者治疗后血磷均较治疗前明显下降,差异有统计学意义(P<0.05);观察组血钙及血钙磷乘积明显低于对照组,差异有统计学意义(P<0.05)。治疗6个月后,对照组显效2例,有效2例,总有效率40%;观察组显效4例,有效3例,总有效率70%;2组总有效率比较差异有统计学意义(P<0.05)。结论:西那卡塞联合骨化三醇冲击及碳酸镧治疗血液透析患者中重度SHPT有较好的疗效,可有效降低iPTH。三种药物联合治疗重度SHPT明显优于单纯骨化三醇冲击加碳酸镧。

Objective:To observe the clinical effect of cinacalcet and lanthanum carbonate combined with large dose calcitriol on hemodialysis patients with severe secondary hyperparathyroidism( SHPT).Methods:20 Hemodialysis patients( 20 cases) with severe SHPT were randomly divided into control and observation groups with10 cases in each.These serum iPTH levels were more than 600 mg/d L.The patients in the observation group were treated with Cinacalcet Hydrochloride Tablets,and the initial dosage was 25 mg/d.The dosage was adjusted according to the patient tolerance,every 2 ~ 4 weeks once,and the maximum dosage was 75 mg/d.The patients in the two groups were all treated with oral large dose of calcitriol 4 ~ 6μg two times per week at night after hemodialysis.The dosage of calcitriol were regulated according to the value of serum iPTH every month.All of the patients were treated with oral 500 mg lanthanum carbonate three times per day.Serum calcium,phosphate and iPTH were measured at baseline and in 6 month after therapy.Results:After treatment,serum iPTH in observation group significantly decreased than in the control group( P < 0.05).Calcium and calcium-phosphorus( Ca × P) in observation group were lower than in the control group( P < 0.05).Conclusion:Cinacalcet combined with large dose of calcitriol and lanthanum carbonate is significantly efficacious in treating severe SHPT.The combination of these three drugs is significantly superior to the combination of calcitriol and lanthanum carbonate in treating severe SHPT.