慢性肾衰竭患者继发甲状旁腺功能亢进的治疗进展

Progress in the treatment of secondary hyperparathyroidism inpatients with chronic renal failure

继发性甲状旁腺功能亢进(SHPT)是慢性肾衰竭的常见并发症之一,1,25-二羟维生素D3(1,25-dihydroxy vitamin D3,1,25-(OH)2-D3)和成纤维细胞生长因子23(fibroblast growth factor 23,FGF23)水平异常及其受体表达下调、钙磷代谢紊乱是SHPT的重要发病机制。鉴于上述发病机制,磷结合剂、活性维生素D和钙敏感受体激动剂等被广泛运用于治疗SHPT。近年来上述药物不断被深入研发并取得良好疗效,对于药物治疗效果不佳的SHPT,甲状旁腺切除术、超声引导下局部注射介入疗法成为有效的治疗手段。在SHPT的治疗过程中,血清钙、磷、全段甲状旁腺激素(iPTH)、25-羟维生素D[25(OH)D]、碱性磷酸酶(ALP)等的监测也非常重要,有利于指导用药及评估疗效。

Secondary hyperparathyroidism(SHPT)is one of the common complications of chronic renal failure.Abnormal levels of 1,25-(OH)2-D3 and FGF 23,down-regulated expression of their receptors,and disorder of calcium and phosphorus metabolism are important pathogenesis of SHPT.In view of the above pathogenesis,phosphorous binders,active vitamin D and calcium-sensitive receptor agonists are widely used in the treatment of SHPT.In recent years,the above drugs have been further developed and achieved good efficacy.For the secondary hyperparathyroidism with poor efficacy of drug therapy,parathyroidectomy and ultrasound-guided local injection interventional therapy have become effective treatment methods.In the clinical treatment of SHPT,the monitoring of serum calcium,phosphorus,intact parathyroid hormone(iPTH),25(OH)D and alkaline phosphatase(ALP)is also very important,which is conducive to the guide medication and evaluation of the efficacy.