西那卡塞联合碳酸镧治疗维持性血液透析患者难治性甲状旁腺功能亢进疗效观察

Efficacy observation of cinacalcet combined with lanthanum carbonate for the treatment of refractory secondary hyperparathyroidism in maintenance hemodialysis patients

目的评价西那卡塞联合碳酸镧对维持性血液透析患者难治性甲状旁腺功能亢进(SHPT)的疗效。方法选取潍坊医学院附属医院2015年7月~2017年1月维持性血液透析伴难治性SHPT患者36例,随机分为对照组和观察组,对照组单用西那卡塞治疗,观察组行西那卡塞联合碳酸镧治疗。比较患者治疗前后1周、1个月、2个月及3个月血清Ca、血清P、PTH指标,同时比较治疗前后两组患者甲状旁腺体积变化及不良反应。结果与治疗前相比,对照组和观察组治疗后血清Ca、血清P、PTH水平均显著降低,差异具有统计学意义(P<0.001);治疗后各检测点两组血Ca水平差异无统计学意义(P>0.05),各检测点观察组血清P水平较对照组降低,差异有统计学意义(P<0.05);治疗后1个月、2个月、3个月观察组PTH水平较对照组降低,差异有统计学意义(P<0.05)。治疗后两组甲状旁腺体积均较治疗前降低,且观察组降低程度优于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,无统计学意义(P>0.05)。结论西那卡塞联合碳酸镧治疗维持性血液透析患者难治性SHPT疗效肯定,具有临床推广价值。

Objective To assess the efficacy of cinacalcet combined with lanthanum carbonate for the treatment of refractory secondary hyperparathyroidism（ SHPT） in maintenance hemodialysis patients. Methods A total of 36 patients who were treated in the Affiliated Hospital of Weifang Medical University from July 2015 to January 2017 for refractory SHPT in maintenance hemodialysis were selected. They were randomly divided into control and treatment groups,and each group had 18 cases. Patients in control group were treated with Cinacalcet Hydrochloride Tablets,and patients in observation group were treated with lanthanum carbonate chewable tablet on the basis of the control group. The serum Ca,serum P and PTH of the two groups before the treatment and after treatment at 1-week,1-month,2-month and 3-months after the treatment were compared. The changes of parathyroid volume and adverse reaction were also involved for comparison. Results Compared with those before treatment,the serum Ca,serum P and PTH levels decreased significantly in the two groups（ P〈0. 001）. Compared with control group,the serum Ca levels had no significant differences at different time points（ P〈0. 05）,the serum P level of observation group at different time points after the treatment were all lower than those in the control group（ P〈0. 05）; the PTH levels decreased significantly after the treatment for 1-month,2-month and 3-moths（ P〈0. 05）. After the treatment,the reduce of parathyroid volume in observation group was siginificantly better than those in the control group,with significant difference between two groups（ P〈0. 05）. The incidence of adverse reaction in two groups had no significant difference（ P〉0. 05）. Conclusion Cinacalcet combined with lanthanum carbonate has curative effect for the treatment of refractory secondary hyperparathyroidism in maintenance hemodialysis patients,which has a certain clinical application value.