婴幼儿原发性甲状旁腺功能亢进所致高钙血症的循证治疗研究

Study on Evidence-based Treatment for Infantile with Hypercalcemia Induced by Primary Hyperparathyroidism

目的:探讨婴幼儿原发性甲状旁腺功能亢进所致高钙血症的最佳治疗方案。方法:评估1例原发性甲状旁腺功能亢进所致的高钙血症患儿情况后,计算机检索Cochrane图书馆、PubMed、维普网、中国知网、万方数据等,获取婴幼儿(儿童)原发性甲状旁腺功能亢进所致高钙血症治疗的临床研究,根据文献类型选用相应评价工具进行质量评价,参考文献证据结合临床及患儿家属意愿制订治疗方案。结果:共检出指南2篇,AGREEⅡ评价分别为高、中等质量;Meta分析1篇,AMSTAR量表评价为中等质量;病例系列报告2篇,病例报告4篇,一般综述4篇,尚无评价工具故未进行评价。结合临床实际情况及家属意愿给予扩容药、利尿药、糖皮质激素、降钙素、双磷酸盐、拟钙剂等药物,治疗75 d后患儿体质量增长、血钙趋近正常。结论:本研究采用循证药学方法,为婴幼儿原发性甲状旁腺功能亢进所致高钙血症确定合理的治疗目标和治疗方案,取得了满意的治疗效果。

OBJECTIVE： To investigate the optimal therapy plan for infantile with hypercalcemia induced by primary hyperparathyroidism. METHODS： After evaluating the condition of a child with hypercalcemia induced by primary hyperparathyroidism, clinical studies about the therapy of infantile （children） with hypercalcemia induced by primary hyperparathyroidism were retrieved from Cochrane library,PubMed,VIP,CNKI and Wanfang database,etc. According to the types of literatures,the corresponding evaluation tools were selected for quality evaluation. Combined with the clinical data and family members’wishes,the treatment plan was formulated. RESULTS：A total of 2 guidelines were identified,and then evaluated as high quality and moderate quality by AGREEⅡ;there was one literature of Meta-analysis,which was evaluated as moderate quality by AMSTAR scale;meanwhile,2 case series reports,4 case reports and 4 reviews were identified,there were no evaluation tool. Combined with clinical practice and family members’wishes,the patients were treated with drugs such as expander,diuretic,glucocorticoid,calcitonin,bisphosphonate and calcimimetic drugs for 75 d. The weight of the child increased and the blood calcium approached the normal. CONCLUSIONS：The satisfactory therapy efficacy is obtained in the infantile with hypercalcemia induced by primary hyperparathyroidism by adopting reasonable therapy target and plan according to evidence-based pharmacy methods.