西那卡塞联合骨化三醇对血液透析继发性甲状旁腺功能亢进患者的疗效观察

Effects of cinacalcet combined with calcitriol on patients with secondary hyperparathyroidism during hemodialysis

目的探讨西那卡塞联合骨化三醇对血液透析继发性甲状旁腺功能亢进患者的疗效。方法选取2017年1月~2019年1月在我院行血液透析继发性甲状旁腺功能亢进患者64例,随机分为观察组与对照组各32例。两组患者继续予以维持性透析治疗,对照组予以骨化三醇治疗,观察组在此治疗基础上加西那卡塞治疗。两组均连用3个月,检测两组治疗前后血清钙、血清磷、全段甲状旁腺激素水平及甲状旁腺体积,并评估其临床疗效及不良反应。结果治疗3个月后两组血清磷与全段甲状旁腺激素水平均较前明显下降,血清钙水平均较前明显升高(P<0.05或P<0.01),且观察组变化幅度较对照组更显著(P<0.05);两组甲状旁腺长、宽、厚及体积均较前明显下降(P<0.05或P<0.01),且观察组下降幅度较对照组更显著(P<0.05)。观察组临床治疗总有效率明显高于对照组(χ^2=4.272,P<0.05)。观察组和对照组不良反应发生率分别为12.50%(4/32)和6.25%(2/32),症状均较轻,两组比较差异无统计学意义(χ^2=0.180,P>0.05)。结论西那卡塞联合骨化三醇治疗血液透析继发性甲状旁腺功能亢进患者的临床效果确切,安全性较好,能明显降低甲状旁腺激素水平及甲状旁腺体积,改善钙磷代谢紊乱。

Objective To explore the efficacy of cinacalcet combined with calcitriol on patients with secondary hyperparathyroidism during hemodialysis.Methods 64 patients with secondary hyperparathyroidism who underwent hemodialysis in our hospital from January 2017 to January 2019 were randomly divided into the observation group and the control group,with 32 cases in each group.Both groups continued to undergo maintenance dialysis,while the control group was treated with calcitriol,and the observation group was treated with cinacalcet on the basis of this treatment.Both groups were treated continuously for 3 months.Serum calcium,serum phosphorus,whole parathyroid hormone levels and parathyroid volume were measured before and after treatment in both groups,and their clinical efficacy and adverse reactions were evaluated.Results After 3 months of treatment,the levels of serum phosphorus and whole parathyroid hormone in the two groups were significantly lower than those before treatment.Serum calcium level was significantly higher than that before treatment(P<0.05 or P<0.01),and the change in the observation group was more significant than that in the control group(P<0.05);the length,width,thickness and volume of parathyroid glands in the two groups were significantly lower than those before treatment(P<0.05 or P<0.01),and the decline in the observation group was more significant than that in the control group(P<0.05).The total effective rate of clinical treatment in the observation group was significantly higher than that in the control group(χ^2=4.272,P<0.05).The incidences of adverse reactions in the observation group and the control group were 12.50%(4/32)and 6.25%(2/32),respectively,and the symptoms were both mild,and the differences were not statistically significant(χ^2=0.180,P>0.05).Conclusion The clinical effect of cinacalcet combined with calcitriol in the treatment of patients with secondary hyperparathyroidism during hemodialysis is definite and safe.It can significantly reduce parathyroid hormone levels and parathyroid volume,and improve calcium and phosphorus metabolism disorders.