射频消融与西那卡塞治疗难治性继发性甲状旁腺功能亢进的临床对比

Comparison of radiofrequency ablation with cinacalcet in treatment of refractory secondary hyperparathyroidism

目的观察并比较超声引导下射频消融与西那卡塞治疗腹膜透析患者难治性继发性甲状旁腺功能亢进(SHPT)的临床效果。方法选取2013年1月至2017年12月在浙江中医药大学附属广兴医院腹膜透析中心规律腹膜透析治疗及随访,并诊断为难治性SHPT的患者24例。其中12例患者采用口服西那卡塞治疗,为西那卡塞组;另12例患者采用射频消融治疗,为消融组。随访2年,观察并比较两组患者治疗前后的全段甲状旁腺激素(iPTH)、血钙、血磷水平、心血管功能、临床症状(皮肤瘙痒、不安腿综合征)改善情况。结果治疗3、6个月时消融组iPTH、血磷水平均明显低于西那卡塞组(均P<0.05);治疗3个月时消融组血钙水平明显低于西那卡塞组(P<0.05)。组内治疗前后比较,西那卡塞组治疗24个月时iPTH、血磷水平均明显降低(均P<0.05);消融组治疗3、6、12、24个月iPTH、血磷水平均明显降低(均P<0.05),治疗3、12、24个月时血钙水平均明显降低(均P<0.05)。两组患者治疗前后心脏瓣膜钙化情况、颈动脉内膜中层厚度、左心室舒张末期内径、室间隔厚度、左心室后壁厚度、射血分数比较差异均无统计学意义(均P>0.05)。组内比较,消融组患者的射血分数治疗后较治疗前有改善(P<0.05)。在治疗6个月时消融组皮肤瘙痒的发生率明显下降且较西那卡塞组明显为低(P<0.05)。两组患者治疗前后不安腿综合征发生率的差异均无统计学意义(均P>0.05)。结论超声引导下射频消融与西那卡塞治疗腹膜透析患者难治性SHPT均有效,均能降低iPTH水平。但西那卡塞治疗起效慢,在12个月内难以见到效果,射频消融治疗起效快,3个月内就见效。射频消融治疗能快速改善心脏射血分数及皮肤瘙痒症状。

Objective To compare the clinical efficacy of ultrasound-guided radiofrequency ablation(RFA)with cinacalcet in treatment of refractory secondary hyperparathyroidism(SHPT)in peritoneal dialysis patients.Methods Twenty four patients with refractory SHPT were treated and followed up in Peritoneal Dialysis Center of Guangxing Hospital from January 2013 to December 2017.Among them,12 patients were treated with oral cinacalcet(cinacalcet group).The other 12 patients were treated with radiofrequency ablation(ablation group).All patients were followed up for 2 years.The levels of iPTH,blood calcium and phosphorus,cardiovascular function and clinical symptoms(pruritus and restless legs syndrome)were observed and compared between the two groups before and after treatment.Results At 3 and 6 months of treatment,iPTH and blood phosphorus levels of the ablation group were significantly lower than those of the cinacalcet group(P<0.05).At 3 months of treatment,serum calciumlevels in the ablation group were significantly lower than those in the cinacalcet group(all P<0.05).iPTH and blood phosphorus levels in the cinacalcet group were significantly decreased at 24 months of treatment(all P<0.05).While in the ablation group,iPTH and blood phosphorus levels were significantly decreased at 3,6,12 and 24 months of treatment(all P<0.05),serum calcium levels were significantly decreased at 3,12 and 24 months of treatment(all P>0.05).There were no significant differences in cardiac valve calcification,carotid intima-media thickness,left ventricular end diastolic diameter,interventricular septumthickness,left ventricular posterior wall thickness,ejection fraction between the two groups before and after treatment(all P>0.05).The ejection fraction of ablation group was improved after treatment compared with that before treatment in both groups(P<0.05).At 6 months of treatment,the incidence of itchy skin in the ablative group was significantly lower than that in the Cinacalcet group(all P<0.05).There was no statistically significant difference in the incidence of restless leg syndrome between the two groups before and after treatment(P>0.05).Conclusion Ultrasound-guided radiofrequency ablation of parathyroid glands and cinacalcet treatment are both effective for refractory SHPT in peritoneal dialysis patients.Cinacalcet has a slow onset of effect,while radiofrequency ablation has a fast effect within 3 months on refractory SHPT.Radiofrequency ablation can rapidly improve cardiac ejection fraction and relief skin itching.