西那卡塞联合骨化三醇治疗继发性甲状旁腺功能亢进患者的临床研究

Clinical trial of cinacalcet combined with calcitriol in the treatment of patients with secondary hyperparathyroidism

目的观察西那卡塞联合骨化三醇治疗继发性甲状旁腺功能亢进患者的临床疗效。方法将我院收治的继发性甲状旁腺功能亢进患者80例,随机分为试验组和对照组,各40例。所有患者均给于常规基础治疗,对照组给予骨化三醇,每次0.25μg,每天1次,口服;试验组在对照组的基础上给予西那卡塞,每次25 mg,每天1次,口服。2组均持续治疗3个月以上。检测2组患者的全段甲状旁腺激素(iPTH)和甲状旁腺的体积、血钙、血磷、肌酸酐(Scr)、尿素氮(BUN)及血清磷酸酶(ALP)、骨钙素(OC)和β胶原特殊序列(β-cross)。结果治疗后,试验组和对照组iPTH分别为(256.80±76.34),(318.50±77.63)mg·L^-1,甲状旁腺体积分别为(1.25±0.16),(1.39±0.21)cm^3,ALP分别为(118.90±26.63),(135.20±27.57)U·L^-1,OC分别为(105.20±17.57),(148.90±16.62)ng·mL^-1。与治疗前比较,治疗后2组iPTH、血磷、ALP、OC和β-cross水平降低,且试验组低于对照组,2组甲状旁腺体积减小,且试验组小于对照组,2组血钙上升,且试验组高于对照组(均P<0.05)。2组治疗前后Scr、BUN变化差异无统计学意义(P>0.05)。结论西那卡塞联合骨化三醇对继发性甲状旁腺功能亢进患者的治疗效果优于常规治疗方案,可有效缓解患者甲状旁腺功能。

Objective To analyze the efficacy of cinacalcet combined with calcitriol in the treatment of patients with secondary hyperparathyroidism. Methods A total of 80 patients with secondary hyperparathyroidism admitted to our hospital were randomly divided into treatment group and control group, 40 patients in each group. All patients were given routine basic treatment, control group was given calcitriol 0.25 μg·time-1, qd, orally;treatment group was given cinacalcet 25 mg·time-1, qd, orally, on the basis of control group. Both groups were treated for more than 3 months. The total parathyroid hormone(iPTH) and parathyroid gland volume, blood calcium, blood phosphorus, serum phosphatase, creatinine(Scr), urea nitrogen(BUN), serum alkaline phosphatase(ALP), osteocalcin(OC) and β collagen specific sequence(β-cross) were dectected in two groups. Results After treatment, the iPTH in treatment group and control group were(256.80±76.34),(318.50±77.63) mg·L-1, parathyroid volume were(1. 25 ± 0. 16),(1. 39 ± 0. 21) cm3,ALP were(118. 90 ± 26. 63),(135. 20 ± 27. 57) U·L-1,OC were(105. 20 ± 17. 57),(148. 90 ± 16. 62) ng · mL-1. Compared with before treatment,the levels of iP TH,blood phosphorus,ALP,OC,and β-cross in two groups were reduced after treatment,and treatment group were lower than those in control group;the volume of parathyroid glands in two groups were reduced,and treatment group was smaller than control group,serum calcium in two groups increased,and treatment group was higher than control group(all P < 0. 05). There was no significant change in Scr and BUN between the two groups before and after treatment(P > 0. 05). Conclusion The combination of cinacalcet and calcitriol is superior to conventional treatment in patients with secondary hyperparathyroidism,can effectively alleviate parathyroid function in patients.