骨化三醇联合西那卡塞治疗维持性血液透析继发性甲状旁腺功能亢进患者的临床价值

Clinical Value of Calcitriol Combined with Cinacalcet in Treatment of Maintenance Hemodialysis Patients with Secondary Hyperparathyroidism

目的研究骨化三醇联合西那卡塞治疗维持性血液透析继发性甲状旁腺功能亢进患者的临床价值。方法选取2015年8月—2018年8月收治的68例维持性血液透析合并继发性甲状旁腺功能亢进患者作为研究对象,按照用药方案的不同分为观察组和对照组,每组34例。2组均行常规血液透析,对照组在常规药物治疗基础上予以西那卡塞片治疗,观察组在对照组的基础上联合骨化三醇胶丸治疗。治疗3个月后比较2组临床疗效、生化指标、甲状旁腺体积变化及不良反应发生情况。结果观察组临床总有效率高于对照组(P<0.05)。治疗后,2组血钙水平高于治疗前,且观察组高于对照组(P<0.05);2组血磷、碱性磷酸酶、全段甲状旁腺激素水平低于治疗前,且观察组低于对照组(P<0.05)。治疗后,2组甲状旁腺的长、宽、厚以及体积均小于治疗前,且观察组小于对照组(P<0.05)。2组皮肤瘙痒、皮下软组织钙化、骨痛以及不宁腿综合征发生率比较差异均无统计学意义(P>0.05)。结论骨化三醇联合西那卡塞治疗维持性血液透析继发性甲状旁腺功能亢进患者的临床效果显著,可有效改善患者的血磷、血钙、碱性磷酸酶、全段甲状旁腺激素水平,且安全性高。

Objective To study clinical value of Calcitriol combined with Cinacalcet in treatment of maintenance hemodialysis patients with secondary hyperparathyroidism.Methods A total of 68 patients with maintenance hemodialysis associated by secondary hyperparathyroidism admitted during August 2015 and August 2018 were divided into observation group and control group(n=34 in each group)according to different medication schemes.The two groups received routine hemodialysis,and then control group was treated with Cinacalcet Tablets on the basis of routine drug treatment,while observation group was treated with Calcitriol Soft Capsules on the basis of treatment for control group.After 3 months of treatment,clinical efficacy,biochemical indexes,changes of parathyroid volume and incidence rate of adverse reactions were compared in two groups.Results The total clinical effective rate in observation group was significantly higher than that in control group(P<0.05).After treatment,levels of blood calcium were significantly higher than those before treatment in two groups,and the level in observation group was significantly higher than that in control group(P<0.05);levels of blood phosphorus,alkaline phosphatase and whole parathyroid hormone were significantly lower than those before treatment in two groups,and the levels in observation group were significantly lower than those in control group(P<0.05).After treatment,values of length,width,thickness and volume of parathyroid glands were smaller than those before treatment in two groups,and the values in observation group were smaller than those in control group(P<0.05).There were no significant differences in incidence rate of skin pruritus,calcification of subcutaneous soft tissue,osteodynia and restless legs syndrome between two groups(P>0.05).Conclusion Calcitriol combined with Cinacalcet in treatment of maintenance hemodialysis patients with secondary hyperparathyroidism may achieve good efficacy and effectively improve levels of blood phosphorus,blood calcium,alkaline phosphatase and whole parathyroid hormone with good safety.