骨化三醇联合西那卡塞对继发性甲状旁腺功能亢进患者血钙血磷iPTH骨质疏松和心脏瓣膜钙化的影响

Effects of Calcitriol combined with Cinacalcet on Serum Calcium Phosphorus iPTH Osteoporosis and Cardiac Valve Calcification in Patients with Secondary Hyperparathyroidism

目的:分析骨化三醇联合西那卡塞对继发性甲旁亢患者血钙、血磷、全段甲状旁腺激素(iPTH)、骨质疏松和心脏瓣膜钙化的影响。方法:采用回顾性研究,收集本院60例行维持性血液透析伴有继发性甲旁亢患者的临床资料,根据治疗方法的不同,分为A组(12例)应用西那卡塞,B组(30例)应用骨化三醇,C组(18例)应用骨化三醇联合西那卡塞。比较三组患者治疗前后iPTH、血钙、血磷、心脏瓣膜钙化及骨质疏松发生等差异。结果:治疗后,A组血钙浓度较治疗前显著下降(P<0.05),B组血钙浓度较治疗前显著升高(P<0.05),而C组血钙浓度与治疗前比较无明显变化(P>0.05);相比治疗前,A、C组治疗后血磷浓度显著下降(P<0.05),B组治疗后血磷浓度并无明显变化(P>0.05);与治疗前相比,A、B、C组治疗后iPTH浓度显著下降,且C组治疗后水平明显优于其它两组(P<0.05)。与治疗前相比,A、B组治疗后心脏瓣膜钙化程度并无明显变化(P>0.05),而C组治疗后心脏瓣膜钙化程度明显减轻(P<0.05)。治疗后,A、B组骨质疏松发生率与治疗前比较,并无明显差异(P>0.05);相比治疗前,C组治疗后骨质疏松发生率显著降低(P<0.05)。C组不良反应发生率较A、B组显著降低(P<0.05)。结论:骨化三醇联合西那卡塞可促进继发性甲旁亢患者血钙、血磷浓度维持在正常范围,控制iPTH水平,亦能有效减轻心脏瓣膜钙化的程度,减少骨质疏松的发生,二者联合用药的治疗效果较单独用药的疗效更佳,值得临床应用。

Objective:To analyze the effects of calcitriol combined with cinacalcet on serum calcium,phosphorus,intact parathyroid hormone(iPTH),osteoporosis and cardiac valve calcification in patients with secondary hyperparathyroidism.Methods:The clinical data of 60 patients with secondary hyperparathyroidism who underwent maintenance hemodialysis were collected as a retrospective study.According to the different treatment methods,they were divided into group A(12 cases),group B(30 cases),and group C(18 cases).The differences of iPTH,blood calcium,blood phosphorus,heart valve calcification and osteoporosis were compared between the two groups before and after treatment.Results:After treatment,the serum calcium concentration in group A decreased significantly(P<0.05),while that in group B increased significantly(P<0.05),while that in group C did not change significantly(P>0.05);compared with before treatment,the serum phosphorus concentration in group A and C decreased significantly(P<0.05),while that in group B did not change significantly(P>0.05);and compared with before treatment,the concentration of iPTH in group A,B and C decreased significantly after treatment.After treatment,the level in group C was significantly better than that in other two groups(P<0.05).Compared with before treatment,there was no significant change in the degree of cardiac valve calcification in group A and B after treatment(P>0.05),while the degree of cardiac valve calcification in group C was significantly reduced after treatment(P<0.05).After treatment,the incidence of osteoporosis in group A and B was not significantly different from that before treatment(P>0.05);compared with before treatment,the incidence of osteoporosis in group C was significantly lower after treatment(P<0.05).Conclusion:Calcitriol combined with cinacalcet can promote the maintenance of serum calcium and phosphorus concentration in normal range and control the level of iPTH in secondary hyperparathyroidism patients.It can also effectively reduce the degree of cardiac valve calcification and the occurrence of osteoporosis.The therapeutic effect of the combined use of calcitriol and cinacalcet is better than that of single usage,so it is worthy of clinical application.