骨化三醇不同剂量及给药途径对血液透析合并重度继发性甲状旁腺功能亢进患者疗效

Therapeutic effect of different doses and routes of administration of calcitriol on hemodialysis patients with severe secondary hyperparathyroidism

目的探讨不同剂量及给药途径的骨化三醇对血液透析合并重度继发性甲状旁腺功能亢进的疗效。方法60例血液透析合并重度继发性甲状旁腺功能亢进患者随机分为对照组(常规剂量口服骨化三醇),冲击治疗组(大剂量服用骨化三醇)及静脉用药组(透析后静脉给予骨化三醇注射液),每4周对血清全段甲状旁腺素(i-PTH)、钙、磷进行检测,并观察不良反应。结果服用12周后,对照组甲状旁腺素水平为(697.5±164.3)pg/ml,相较于治疗前(761.4±184.6)pg/ml,变化不明显(P>0.05),对重度继发性甲状旁腺功能亢进疗效欠佳;冲击治疗组疗效显著[治疗前:(757.6±170.3)pg/ml,治疗后:(417.6±157.8)pg/ml,P <0.01],但是部分患者出现高钙血症;而静脉用药组疗效最佳[治疗前:(814.7±197.8)pg/ml,治疗后(227.4±106.4)pg/ml,P <0.01],且较少发生高钙血症。结论目前,对血液透析合并重度继发性甲状旁腺功能亢进患者,骨化三醇注射液疗效显著,且不良反应较小,可以作为优先选择。

Objective To investigate the efficacy of calcitriol at different doses and routes of administration for hemodialysis with severe secondary hyperparathyroidism.Methods Sixty patients with hemodialysis and severe secondary hyperparathyroidism were randomly divided into the control group （conventional dose of oral calcitriol）, the shock treatment group （large dose of calcitriol） and the intravenous drug group （intravenous administration of calcitriol after dialysis）, serum iPTH, calcium and phosphorus were detected every 4 weeks, and adverse reactions were observed.Results After 12 weeks of treatment, the level of parathyroid hormone in the conventional dose of calcitriol treatment group was （ 697.5 ± 164.3 ） pg/ml, which was not significantly different from that before treatment （ 761.4 ± 184.6 pg/ml, P 〉 0.05 ）.The high-dose calcitriol shock treatment was moreeffectivethan theconventional dose of calcitriol, but some patients had hypercalcemia. The intravenous medication had the best effect on severe secondary hyperparathyroidism（before treatment： 814.7 ± 197.8 , after treatment： 227.4 ± 106.4 , P 〈 0.01 ）, and hypercalcemia was rare.Conclusion At present, calcitriol injection can be prioritized in terms of the treatment of hemodialysis patients with severe secondary hyperparathyroidism.